Data Access Request In person Proxy (a copy of the power of attorney shall be enclosed) Subject's Data Name Date of Birth Telephone Email Address for Correspondence State Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other Country With Regards to Right of access Right to rectification Right to erasure ('right to be forgotten') Right to restriction of processing Right to object Right to data portability Description of the request Preferred way for feedback on the request In writing to the correspondence address Other - Submit
