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2. Instructions
   To expedite your request and to eliminate opportunities for error, please fill out this form completely with detailed information. Please identify specifically the records you are requesting. Once this form has been received, the Clerk's office has 72 working hours to produce said documents. You will be contacted within the 72 working hour window to view the documents requested. Original documents may never leave the Clerk's Office. If copies are needed, please indicate it at the bottom of this form. Copies will only be made at the time of pick-up. If copies are requested, please allow at least 15 minutes for copies to be made. While there is no charge to view documents; however, if copies exceed 5 pages, a rate of $1.00 per page will apply.
   
   Documents will not be copied until payment has been made. Payments must be made in check or money order payable to the City of Leesville. Custodian of Records is Sonny Harrell. Sonny can be reached by calling (337) 238-2250.
   
   Inquiries for traffic and criminal records, please contact Leesville City Court at 337-238-1531 or you can fax us at 337-392-8582.
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. Company (if applicable)
18. Records Request Description
    (Specific Items, item details, date(s), etc.)
20. Check one to indicate

    1. I wish to inspect the requested records and do not want copies at this time
    2. I would like copies of the requested records and understand that I will be contacted for pick up and any cost associated with the copies
22. eSignature
23. Date
    Date
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field