Colorado Privacy Law Request

All fields with an (*) are mandatory

REQUEST FOR INFORMATION COLLECTED | REQUEST FOR IDENTIFICATION | REQUEST FOR DELETION OF INFORMATION COLLECTED BY RAUSCH STURM LLP (COLORADO RESIDENTS ONLY)

First Name*

Last Name*

Street Address*

Address Line 2

City*

State*

Zip Code*

Phone Number*

Email Address*

Account Number (if known)

Last 4 Digits of Social Security*

Date of Birth*

Request

Pursuant to the Colorado Protection Act, I hereby declare under penalty of perjury that the information provided above is true and correct and that I (the individual described above) am the individual that is providing the information above.

I hereby request confirmation as to whether or not Rausch Sturm is processing my personal data.

I hereby request that Rausch Sturm correct inaccuracies in my personal data.

I hereby request that Rausch Sturm delete personal data provided by or obtained about me.

I hereby request that Rausch Sturm provide me with a copy of my personal data.

- OR -

I hereby am appealing Rausch Sturm’s previous response to my Colorado Privacy Act request.

Today's Date*

E-Signature*

By submitting this form I am authorizing Rausch Sturm LLP to contact me using the phone numbers or email address supplied.