GEORGIA OPEN RECORDS ACT - REQUEST FORM
GEORGIA OPEN RECORDS ACT - REQUEST FORM
Requester's Name: Telephone #:
Company Name: FAX #:
Email Address:
Mailing Address:
Identify Requested Record(s):
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To be completed by the DBHDD organizational unit
Date Received: Time Received:
Request Received By: Mail Fax E-mail Phone Visit
Name of DBHDD Responder:
DBHDD Organizational Unit:
Determination: Record(s) Subject to Disclosure Record(s) NOT Subject to Disclosure
Date Requester Advised of Availability/
Non-availability of Record(s): Date Record(s) Made Available:
Method: Records Prepared for Viewing Computer Records Copied to Disk Photocopies Made
Electronic Transmission
Other; specify
Number of Documents (approximate number of pages) Made Available: Number of Copies Provided: Amount Charged:
Additional Comments:
Attachment #1
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