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2. Every effort will be made to expedite your request for information. Please be aware that some requests may involve duplicating large volumes of material or require lengthy research, so charges will be imposed. Please complete the information and submit to the County Administrator's Office (click submit when complete). If you have any questions regarding the form or the procedure, please contact the County Administrator's Office at 804-492-3625.
4. Requestor's Information
6. First Name*
7. Last Name*
9. Company Name if Applicable
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
18. Email Address
20. Are you a resident of Virginia?

    1. Yes
    2. No
22. I am requesting the following information:
    Please be specific. This will assist us in processing your request and help to minimize your cost. Include details and a time frame of your request if applicable.
24. Receipt of Information

    1. I will pick up this information once I have been notified that it is ready.
    2. I would like this information to be mailed to me at the above address and understand that I will be responsible for postage charges.
    3. I would like this information, if possible, to be emailed to me at the email address provided.
26. I understand that if I owe the County for a previous FOIA request, the County has the right to refuse to fulfill future FOIA requests until those fees are satisfied.
28. Date
    Date
29. Signature
    By typing your full name in this box, you are signing this FOIA request form.
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field