Ss-6075 - Public Record Request - Tennessee printable pdf download

Ss-6075 - Public Record Request - Tennessee

State of Tennessee

Public Record Request

Department of State

Division of Charitable Solicitations & Gaming

William R. Snodgrass Tennessee Tower

312 Eighth Avenue North, 8

Floor

(615) 741-2555

(615) 253-5173 fax

Name of Person / Organization Requesting Record: _________________________________________________

__________________________________________________________________________________________

Address: ___________________________________________________________________________________

(Street)

(City)

(State)

(Zip)

Telephone Number: (___)__________ Fax Number: (

)___________ Email Address:__________________

______________________________________________________________

Information requested: _______________________________________________________________________

__________________________________________________________________________________________

______________________________________________________________

SIGNATURE

I certify that the information furnished in this Public Record Request is true and correct to the best of my

knowledge.

_______________________________________________________

___________________

Signature of Person Requesting Information

Date

_________________________________________________

Print name

ss - 6075

RDA pending

Ss-6075 - Public Record Request - Tennessee