Your Email Address: * Your Name First Name: * Middle Name: Last Name: * Name Prefix * Miss Ms. Mrs. Mr. Other Other Name Prefix Your Address Street / Apartment No. / P.O. Box / RR: * City / Town: * Province / Country: * Postal Code: * Your Telephone / Fax Numbers Daytime Phone Number: Alternate Phone Number Fax Number: Details of Requested Information Information Requested: Please describe the records you are requesting. Be as specific as possible, as this will assist the request process. Attach any supporting documentation. Supporting Documents: Files must be less than 2 MB.Allowed file types: pdf. Are you making a request for correction on behalf of another person: Yes No If so, please submit as appropriate: A) That person's signed consent for disclosure, or B) Proof of authority to act on that person's behalf. Proof for Request on Behalf of Another Person: Files must be less than 2 MB.Allowed file types: pdf. Preferred Method of Access to Records: * Examine Original Receive Hard Copy Receive PDF Copy Via Email
