Form Center

2. Request for Records or for a Copy
4. The section below is to be completed by person making the request.
6. Instructions

   You may fill this out and submit your request by email, but you will need to mail in your payment of $12.00 before record search will be done.

8. Name
10. Address
12. City
13. State
14. Zip
16. Daytime Phone*
17. Email*
19. I certify that I do not intend to, and will not:
    - Use any list of names or addresses contained in or derived from the records or information requested for the purpose of selling or offering for sale any property or service to any person listed or to any person who resides at any address listed
    - Sell, give, or otherwise make available to any person any list of names or addresses contained in or derived from the records or information for the purpose of allowing that person to sell or offer for sale any property or service to any person listed or to any person who resides at any address listed
    
    See K.S.A. 45-230.
21. Record Sought
    Please provide as specific a description as possible of the records you desire to inspect or for which you request a copy. Include records titles and dates as well as the name of the court which holds the record. Also, name, date of birth, social security number (if available) of person whose record is to be inspected or copied.
23. Criminal/Juvenile/Traffic

    1. Criminal/Juvenile/Traffic
    2. Probate
    3. Divorce/ Child Support/ Custody
    4. Civil/Limited Action
    5. Other

    Please list below the information you are wanting.
25. Description of Record*
26. Number of Copies Desired*
28. Description of Record*
29. Number of Copies Desired*
31. Charges
    A charge for providing access to public records is authorized by state law and has been established by the Kansas Supreme Court. Charges are set to compensate for the actual costs in honoring your request. The fee schedule established for this Judicial District is posted in the Office of the Clerk of the District Court. The charge for access to and/or copies of the record(s) you have requested is estimated to be: $12.
    
    Prepayment of the above amount may be required.
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field