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2. REQUEST FOR GOVERNMENT DATA

4. Today's Date
   Today's Date
6. Description of data requested:
8. If the data you are seeking is about an individual, please provide to the extent you know:
10. Last Name
11. First Name
12. Middle Name
13. Date of birth
    Date of birth
15. Other names (including aliases, birth name, nicknames, maiden name, etc.):
17. I would like to (pick one):

    1. Inspect (look at) the requested data (no charge)
    2. Receive copies of the requested data (a fee may apply)

19. If you seek to inspect the data without charge, arrangements will be made to permit its inspection during normal business hours where the data is kept or at the Isanti County Sheriff’s office.

21. OPTIONAL CONTACT INFORMATION

    The Isanti County Sheriff’s Office cannot require you to provide identifying information when making your request but if you do not provide a way to reach you, we cannot ask any follow-up questions about your request or let you know when the data are ready. Please provide any optional contact information below:

23. Last Name
24. First Name
25. Middle Name
26. Date of birth
    Date of birth
28. Street
30. City
31. State
32. Zip Code
34. Email
35. Telephone
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field