IN THE MUNICIPAL COURT

FOR THE CITY OF (City), WYOMING

I, THE UNDERSIGNED DO HEREBY REQUEST A RECORDS CHECK ON THE FOLLOWING LISTED PERSON.

NAME___________________________________________________

DATE OF BIRTH__________________________________________

DATE OF CHARGES_______________________________________

CHARGES________________________________________________

ANY OTHER INFORMATION THAT IS KNOWN ABOUT THE

CASE____________________________________________________

_________________________________________________________

I REALIZE THAT THE RECORDS CHECK, WHETHER ANY INFORMATION IS FOUND OR NOT, WILL COST $10.00 IN ADDITION TO ANY COPYING FEES INCURRED. THIS IS PAYABLE IN ADVANCE BY CASH, CERTIFIED CHECK OR MONEY ORDER, MADE OUT TO THE CITY OF (City). YOUR INFORMATION WILL BE MAILED TO YOU WITHIN 2 DAYS OF THIS DATED REQUEST.

REQUESTING PARTY NAME________________________________

MAILING ADDRESS_______________________________________

CITY/STATE/ZIP__________________________________________

TELEPHONE NO.__________________________________________