Open Records Request Form - Public Protection Cabinet - Department Of Professional Licensing

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P
P
C
UBLIC
ROTECTION
ABINET
O
O
P
FFICE OF
CCUPATIONS AND
ROFESSIONS
P.O. Box 1360, Frankfort, Kentucky 40602 ~ 911 Leawood Drive, Frankfort, Kentucky 40601
Phone: (502) 564-3296, Fax: (502) 564-4818 ~
OPEN RECORDS REQUEST
1. MAILING INFORMATION
First Name
Last Name
Middle I.
Street Address
City
State
Zip Code
Phone Number
Email Address
Date of Request
Signature
2. REQUEST INFORMATION
In accordance with KRS 61.870 – 61.884, I hereby submit a request for the following document(s):
Name of board:
□
Non-Commercial
A.
The use of the information is for (check one):
Commercial
B.
If commercial, what is the intended use of the information provided by the Office of Occupations and
Professions? (KRS 61.874 (b))
Please be advised that there is a charge of .10 per page.
Once payment is received we will fulfill your request.
Page 1 of 1

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