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2. Dear Office Manager (or designee):
4. (i), (We), are hereby requesting that (I) (We):*

   1. Inspect the following records at the Bartlett Fire Protection District's Administrative Office
   2. Receive copies of the following records from the Bartlett Fire Protection District
6. Records requested
   Please be specific in listing records
8. Will the records received or requested or the information derived thereof be used in any form of sale, resale, or solicitation or advertisement for sales or services?

   1. Yes
   2. No
10. Copy Fee*

    1. I understand that if i request that the records be copies, I may be charged a fee due in full before copies are made
12. Requestor(s) Name*
13. Date of Request*
    Date of Request
15. Requestor's Address*
17. Requestor's Phone Number*
18. Requestor's Email Address
20. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
22. Electronic Signature*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field