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2. Defendant
4. DOB
6. Last 4 digits of SS Number
8. Additional Information (i.e. citation number, etc.)
10. Requested By
12. Name
14. Address
16. Contact Number
18. Upload Photo I.D. Only
20. Would you like to receive your request through email, a fax or through the mail? Please provide the email address, mailing address or fax number where you would like to receive your request. ONLY fill out the information for the method you prefer.
22. Email Address
24. Fax Number
26. Mailing Address
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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