Department of Business and Professional Regulation

Mail Completed Form To: Department of Business and Professional Regulation Attention: Office of Open Government 2601 Blair Stone Road Tallahassee, Florida 32399-2203

Or Fax to: 850.488.5761

Public Records Request Form

Date: ______

Name (Optional): ______

Email or Mailing Address: ______

______

Phone Number (Optional): (______) ______

Please provide as much detail as possible about the records you are requesting such as date range, domain names, file numbers, etc. Attach additional sheets if necessary. ______