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OFFICIAL APPLICATION

Record request form

AgencyPublic RecordsUsePersonal file
Question 1 of 5

Whose record are you requesting?

Maya R. Chen
Question 2 of 5

What do you need the record for?

A certified copy for my personal file
Question 3 of 5

Which office has the record?

The County Clerk
Question 4 of 5

Where should they mail the copy?

214 Cedar Ave, Apt 6
Question 5 of 5

When are you signing this request?

September 26, 2026
1Information Docgle places on the form
Applicant legal nameMaya R. Chen
Document purposeCertified copy request
Issuing officeCounty Clerk
Mailing address214 Cedar Ave, Apt 6
Signature date09 / 26 / 2026

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