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Lumpkin County Sheriff's Office Open Records Act Request Form

2. Open Records Act Request Policy
   View Open Records Act Request Policies

   Please visit our Open Records Act Requests page to learn more about our policies and points of contact.

4. Time
   Time

   Time

6. First Name

7. Last Name

9. Street Address

11. City

12. State

14. Zip Code

15. Country

17. Phone Number

18. Email Address

20. In order to reduce administrative and copying charges, please provide a detailed description of the records that you are requesting. For example please state arrest, incident or accident report, etc or explain in detail the type of information you are trying to obtain.

    In order to reduce administrative and copying charges, please provide a detailed description of the records that you are requesting. For example please state arrest, incident or accident report, etc or explain in detail the type of information you are trying to obtain.

22. Pursuant to the open records law, I would like to inspect and obtain a copy of the following Lumpkin County Records.

24. Name of Individual (Victim/Suspect)

26. Date & Time of Incident:

27. Case Number:

29. Location of Incident:

31. I understand that pursuant to O.C.G.A 50-18-71, I may be charged administrative, supply and copying fees for the cost to search, retrieve, copy and supervise access to the requested documents. This administrative fee represents the hourly rate of the lowest paid full time employee with the necessary training to respond to my request, with no charge for the first fifteen minutes that it takes to respond to the request. A cost worksheet will be provided explaining all fees associated with receiving this request. I agree to pay all copying and/or administrative cost incurred with fulfilling my open records request.

    I understand that pursuant to O.C.G.A 50-18-71, I may be charged administrative, supply and copying fees for the cost to search, retrieve, copy and supervise access to the requested documents. This administrative fee represents the hourly rate of the lowest paid full time employee with the necessary training to respond to my request, with no charge for the first fifteen minutes that it takes to respond to the request. A cost worksheet will be provided explaining all fees associated with receiving this request. I agree to pay all copying and/or administrative cost incurred with fulfilling my open records request.

33. If there are any questions about my request, I may be contacted at:

35. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature

39. Address

41. City

42. State

43. Zip Code

45. If the records are available, please allow three business days for your request to be processed. If the request cannot be processed within three business days a timetable for their release will be provided.

    If the records are available, please allow three business days for your request to be processed. If the request cannot be processed within three business days a timetable for their release will be provided.

47. For Office Use Only

49. Codes

    1. Approved
    2. Denied

51. Records Clerk:

Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field