Response

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Phone

* Are you employed by a federal agency, a branch of the Armed Services or a federal contractor? Yes
No

If so, which one?

* Have you contacted any other elected official regarding this case? Yes
No

Official's Name?

* Please explain the problem and the resolution/outcome you are seeking.

Please attach any relevant files or documents.

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To be able to assist you, we must have a signed privacy release form that clearly outlines your problem and the remedy you are seeking. By checking the box below you are giving our office permission to look into the matter on your behalf. Please make sure to attach below any relevant identifying information and supporting documents which relate to your inquiry.

I hereby request the assistance of the Office of Representative Daniel Webster to resolve the matter described below. I authorize Rep. Webster to receive any information that they might need to provide this assistance. The information I have provided to Rep. Webster is true and accurate to the best of my knowledge and belief. The assistance I have requested from Rep. Webster is in no way an attempt to evade or violate any federal, state, or local law. I agree