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2. Please check all that apply*

   1. I would like to inspect (view free of charge) the records.
   2. I would like to receive a copy of the records. I understand that I may be responsible for fees associated with copying charges or research charges as permitted by UCA 63-2-203.
   3. This report is Domestic Violence related wherein I am the victim.
4. Records Price List*

   Reports cost $10.00 per report. CDs (of photos) cost $15.00 per CD Please call (801) 576-6300 with questions regarding prices.

   1. I have read and understand the cost of the records I have requested.
6. If the records are not public, please explain why you believe you are entitled to access.*

   1. I am the subject of the record.
   2. I am the person who provided the information.
   3. I am the parent of a minor, who is the subject of the report.
   4. Other
8. If you selected "Other", please explain:*
10. Are you an attorney representing the subject of the record?
    -- Select One --NoYes
11. Upload Client Release Form
13. First Name*
14. Last Name*
16. Daytime Phone*
17. Cell Phone
19. Address*
21. City*
22. State*
23. Zip*
25. Date of Request*
26. Email Address
28. If you would like to have the requested documents emailed to you, please submit a copy of your government issued identification.
30. Records Requested (Please include case numbers, if possible.)*
32. PLEASE READ AND CHECK THE FOLLOWING BEFORE SUBMITTING THIS REQUEST:*

    Your request for records will be processed in accordance with the requirements of the Government Records Access Management Act (GRAMA) 63-2-101 etc. Seq., Utah Code. Your request will be handled as soon as reasonably possible, but may take up to ten business days to be granted. The records that may be provided to you, subsequent to your request, may contain information that is classified as “Protected”, and will be edited in accordance with GRAMA and may only be disclosed under certain circumstances. 63-2-2-2 (U.C.A)

    1. I have read, understand and agree to this information.
34. Requestor: Please sign this form by entering your initials.
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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