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2. Frederick County MarylandPublic Information Act Request Form
4. Please provide the following information:
6. Applicant First and Last Name*
   Business/Agency Name
8. Street Address*
9. City*
11. State*
12. Zip Code*
14. E-mail Address*
15. Phone Number*
    xxx-xxx-xxxx
17. Describe the records being requested. (Be as specific as possible in describing the name, type of record, subject matter, date and any other information that will help us to quickly identify the records. If you are requesting records from a particular county division or agency, include this information in the description of the records.)
19. Are you making this request on behalf of:

    1. An elected official
    2. A media outlet
21. How do you want to receive the records?*

    choose one

    1. By mail (address included above)
    2. Will pick up when notified
    3. Inspection only
    4. By email
22. Email*
24. Form submitted to the Office of the County Attorney12 E. Church Street - Frederick, MD 21701 - 301-600-1030
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field