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The following form may request personally identifiable or protected health information. Please see our Privacy Policy for details. This form is encrypted. SSL is on to ensure a higher level of security. A recaptcha must be completed before submission, you cannot save progress, and you cannot receive an email copy of the form.

GIS Data Request Form

  1. Do you intend to redistribute or sell, in either the original format or in a derivative or value‐added format, any of the data you have requested?*
  2. Do you agree?*

    By clicking "I agree", you agree and acknowledge that 1. Your application will not be "Signed" in the sense of a traditional paper document and 2. By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

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