Public Records

Public Records Request

In order to submit a public records request, please use the form below or print this form and mail it to our Records Custodian/Administrative Assistant. View the fee schedule here.

Completion of this form is not mandatory. Your refusal to complete or provide any and/or all information on this form will not limit or condition your right to promptly inspect and/or receive copies or reproductions of the requested records within a reasonable time period. (R.C. § 149.43(B)(5)).

Your Name

Street Address

City

State

Zip Code

Phone

(###)

###

####

Record(s) Requested:

With as much specificity as possible, please describe what records you are requesting.

Inspection of Record(s): (Check Your Preference Below)

There is no charge to inspect public records while in the Delaware-Morrow Mental Health & Recovery Services Board office, where the records are kept. The Delaware-Morrow Mental Health and Recovery Services Board has adopted and provides photocopies and reproductions of public records in accordance with the Public Records Fee Schedule & Policy Regarding Fees for Copies & Reproductions. How would you like to inspect/receive the records?

Inspect in the office

Emailed to me

Copied/reproduced and I will pick them up

Copied and mailed to me at the address on this form

Medium:

Preferred Medium (i.e., Paper, email, (PDF or locked format only), Flash Drive, etc.) for Copy/Reproduction.* *Medium is limited by the determination of the record custodian (manager) as to the types of media upon which the record can reasonably be duplicated as an integral part of the normal operations of the public office or records custodian (manager).

Intended Use for the Requested Information:

An indication of the intended use for the information may enhance the Board’s ability to identify, locate or deliver the requested public records.