Pursuant to the Kentucky Open Records Act (“the Act”), KRS 61.870 et seq., the undersigned requests to inspect the public records which are described below.

Requester’s contact information.

Statement regarding the use of public records.

KRS 61.870(4) defines “commercial
purpose” as “the direct or indirect use of any part of a public record or records, in any form,
for sale, resale, solicitation, rent, or lease of a service, or any use by which the user expects a
profit either through commission, salary, or fee.” However, “commercial purpose” does not
include the publication or related use of the public record by a newspaper or periodical, by a
radio or television station in its news or informational program, or by use in the prosecution
or defense of litigation by the parties to such an action or their attorney.

Statement regarding residency.

Pursuant to KRS 61.876(4), the Office of Attorney General has promulgated by
administrative regulation this form. See 40 KAR 1:040.