REQUEST FOR RECORDS

FAX: 801.565.8978
EMAIL: melanieb@wjordan.com

REQUESTOR NAME:

First Name    Last Name

Street Address

City      State    Zipcode

Daytime Phone   -      Fax   -

Email Address

Description of record(s) sought

Department Requested From



I authorize costs of up to $ .
If costs are greater than the amount I have specified, I further understand that the office will contact me and will not respond to a request for copies if I have not authorized adequate costs.

PRINT NAME       DATE September 25, 2017