County of Huntington - Access to Public Records Request

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Name of requesting party:

Address

City

State

ZIP

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Second portion of ZIP Code is optional.

Phone number:

Phone number: Area Code-Phone number: Prefix-Phone number: Line Number ext Phone number: Extension

Email address:

Date and time of request:

MonthDay Year, HourMinute : AM/PM

Digital signature of requesting party (type name in field):

Information requested (please be specific):

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Does requesting party request to inspect or to buy copies of the information being requested?

Department having information requested (if known):