Virginia 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 (VIRGINIA 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 Virginia Consumer Data 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 and request to access such personal data.

I hereby request that Rausch Sturm correct the following inaccurate personal data about me.

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 that I have previously provided to Rausch Sturm.

APPEAL: I hereby am appealing Rausch Sturm’s previous response to my Virginia Consumer Data Protection Act request. The reason for my appeal is

I hereby request that Rausch Sturm not process my personal data for targeted advertising, the sale of personal data or profiling in furtherance of decisions that produce legal or similarly significant effects concerning me.

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.