Administrative Office of Pennsylvania Courts GOVERNMENT ACCESS REQUEST FORM Name________________________________________________________ Government Agency/Dept._______________________________________ Mailing Address_______________________________________________ ____________________________________________________________ City ___________________________State________Zip______________ SUBMIT TO: Administrative Office of Pennsylvania Courts Information Technology ­ Public Access Unit PO Box 62307 Harrisburg, PA 17106-2307 Phone: 717-795-2000 Fax: 717-795-2002 E-mail: ediin@pacourts.us E-Mail________________________________ Phone____________________________Fax______________________________ Reason for Request:________________________________________________________________________________________ DESCRIPTION OF REQUEST REMARKS ­ ADMINISTRATIVE OFFICE OF PENNSYLVANIA COURTS (AOPC) USE ONLY Requestor acknowledges that the information and its receipt are subject to all relevant legal authority as well as the following: 1. 2. A copy of this information may be supplied to the court related to this request. The case information contained in the Pennsylvania Appellate Court Management System (PACMS), Common Pleas Criminal Court Case Management System (CPCMS), and Magisterial District Judge Automated System (MDJS) is not supported by fingerprints. Therefore, it should not be used for the purposes of linking cases to specific individuals. The AOPC will not automatically update the information contained in the PACMS, CPCMS, or MDJS. Recipient acknowledges responsibility to comply with all orders to expunge or correct the data provided. The UJS and AOPC makes no representation as to the accuracy, completeness or utility, for any general or specific purpose, of the information provided and as such, assumes no liability for inaccurate or delayed data, errors or omissions. Use of this information is at the risk of the requestor. Some of the information provided may be of a nature or class not subject to disclosure under the UJS Electronic Case Record Public Access Policy. Your request for information is being fulfilled consistent with the provisions of the UJS Electronic Case Record Public Access Policy. 3. 4. 5. 6. 7. SIGNATURE______________________________________________________________ DATE_____________________ American LegalNet, Inc. www.FormsWorkFlow.com