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2. Requester's Contact Information
4. Applicant Name*
6. Mailing Address*
8. City*
9. State*
10. Zip*
12. Email Address (if applicable):
14. Records to be Inspected*

    Statement regarding the use of public records. KRS 61.870(4) defines “commercial purpose” as “the direct or indirect use of any part of a public record or records, in any form, for sale, resale, solicitation, rent, or lease of a service, or any use by which the user expects a profit either through commission, salary, or fee.” However, “commercial purpose” does not include the publication or related use of the public record by a newspaper or periodical, by a radio or television station in its news or informational program, or by use in the prosecution or defense of litigation by the parties to such an action or their attorney.

16. This request is (choose one):*

    1. NOT for a commercial purpose; or
    2. FOR a commercial purpose.
18. Statement Regarding Residency

    I further state that I am a resident of Kentucky because I am (please check one):

20. 1. An individual residing in the Commonwealth; or
    2. A domestic business entity with a location in the Commonwealth; or
    3. A foreign business entity registered with the Kentucky Secretary of State; or
    4. An individual that is employed and works at a location within the Commonwealth; or
    5. An individual or business entity that owns real property within the Commonwealth; or
    6. An individual or business entity that has been authorized to act on behalf of an individual or business entity listed above; or
    7. A news-gathering organization as defined in KRS 189.635(8)(b)1a. to e.
22. Signature*
24. Date
    Date
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field