Public Information Request Form - Youth Court

Step 1 of 2

This form, completed in full, must be received prior to the release of any information. Proper identification must be provided by requester upon submission of this form. Requests for records involving juveniles must be made through the Rankin County Youth Court. Public records requests submitted in the proper form shall be responded to in accordance with §25-61-5 Miss. Code Ann. (1972). Fees for information requested must be paid prior to release of any information. The fee is $10.00 to process this request.

This includes the first report, if there is anything found. There is a $10.00 charge for each additional document found. Tapes, videos, etc. will vary. If requesting by mail, please enclose this form, completed in full, a check made payable to the Rankin County Sheriff’s Department, a copy of your driver’s license, and a self-addressed, stamped envelope.

Please complete the fields below to submit your request for a Public Record.

* Denotes a required field

Requester's Information

Person Requesting Information*

Date*

MonthDay Year,

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

Phone Number

Phone Area Code-Phone 3-Phone 4 ext Extension

Agency/Business/Organization (if applicable)

Please Do Not Complete The Following Field