REQUEST FOR SEARCH AND / OR CASE NUMBER



REQUEST FOR SEARCH AND / OR CASE NUMBER

|Date of Request       |Person Requesting       |

|Type of Case       |Years to be Searched       to       |

| | |

|Name(s) of Plaintiff(s): |Name(s) of Defendant(s): |

|      |      |

|      |      |

|      |      |

|      |      |

All searches are subject to a fee of $.50 cents per year, per name. Search fees must be paid in advance.

If information is to be sent to you, please indicate an address below:

     

Request taken by:     

Additional information may be written on the back of this request.

Rev 01/11

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