2. 
4. Completed by Requestor: (*=Optional)
6. *Requestor Name (Last, First, MI)
7. Date of Request:
9. *Street Address:
10. *Phone Number
12. *City, State, Zip
13. *Email
15. Information requested

    (attach additional sheets if necessary):

    1. Police
    2. Licensing

    1. Utilities
    2. Staff

    1. Permits
    2. Inspections/Violations

    1. Other
17. Detailed description of data requested.
19. If printing, return form to City Clerk:

    Email: clerk@coonrapidsmn.gov - In person: 11155 Robinson Drive, Coon Rapids, MN 55433

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

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