Public Information Request Form - Lincoln County Clerk

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LINCOLN COUNTY CLERK
PUBLIC INFORMATION REQUEST
(Please type or print)
NAME: ___________________________________ TELEPHONE: (
)_______________________
MAILING ADDRESS: _______________________________________________________________
CITY: ________________________________ STATE: ____________ ZIP: ____________________
PLEASE CHECK AT LEAST ONE OF THE FOLLOWING:
I WANT TO INSPECT/REVIEW THIS INFORMATION.
I WOULD LIKE COPIES OF THIS INFORMATION.
I WOULD LIKE A CERTIFIED COPY OF A DOCUMENT.
PUBLIC INFORMATION SOUGHT (be as specific as possible)
________________________________________________________________________________
________________________________________________________________________________
If requesting a copy of a marriage license please provide the following Information:
____________________________________________
Husband’s Name and Date of Birth
____________________________________________
Wife’s Name prior to marriage and Date of Birth
____________________________________________
Date of Marriage
Certified Copy
Yes
No Number of copies: ___________
Remit $1.50 per certified copy
I understand that I will be required to pay the fees imposed by the County of Lincoln, pursuant to the
Inspection of Public Records Act. The County of Lincoln has agreed to provide me with a schedule of
its fees for copying public records, and upon request, will provide me with an estimate of the costs for
copies of the records I am requesting. I understand this is only an estimate and that I will not receive
copies of any public record until I have paid the applicable fees. I also understand some of the
materials enclosed may be provided to me as a community service, and that the County is not
responsible for any error liability contained therein, or any use or misuse of this information.
DATE: ____________________
Signed: ____________________________________________
All requests for copies shall be accompanied by a self -
Mail to: Lincoln County Clerk
addressed stamped envelope and paid for before
PO Box 338
copies will be sent.
Carrizozo, NM 88301

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