Transcription of Barbara Gladden Adamick Montgomery County …
1 Rev. 10/2015 Barbara Gladden Adamick Montgomery County district Clerk Proudly Serving the Citizens of Montgomery County Please Print or Type Fees: $5 per Name, per Ten year search Date Requested: ____/____/____ Date to be searched: _____ Name(s) to be searched: _____ (Please Print) (Each last name is an additional $5 per 10 years) Customer Requesting: _____ Phone Number: (_____) - _____-_____ (Please Print) Customer Signature: _____ Amount Paid $_____ (Cash, Money Order, Cashier s Check, or Attorney Check # _____) (Circle one) FOR district CLERK USE ONLY Date completed: _____/_____/_____ Completed by: _____ Called: _____ _____/_____/_____ Records found ___ ___: _____ _____ Please Circle One Below: Pick-up (Signature Required) Mail (A self-addressed stamped envelope will be required) Signature & Date _____ Date Mailed _____ by Clerk _____ Criminal Name search
