STANDARD RIGHT-TO-KNOW REQUEST FORM

 

DATE REQUESTED: _________________

 

REQUEST SUBMITTED BY:           □E-MAIL              □ U.S. MAIL              □ FAX              □ IN-PERSON  

 

REQUEST SUBMITTED TO (Agency name & address):__________________________________________

 

________________________________________________________________________________________

           

NAME OF REQUESTER: ___________________________________________________________________

 

STREET ADDRESS:_______________________________________________________________________

 

CITY/STATE/COUNTY/ZIP(Required): ________________________________________________________

 

TELEPHONE (Optional):_____________________    EMAIL (optional):_____________________________

 

RECORDS REQUESTED: *Provide as much specific detail as possible so the agency can identify the information.

Please use additional sheets if necessary

 

 

 

 

 

 

DO YOU WANT COPIES?  □ YES  □ NO

DO YOU WANT TO INSPECT THE RECORDS?  □ YES  □ NO

DO YOU WANT CERTIFIED COPIES OF RECORDS? □ YES □ NO

DO YOU WANT TO BE NOTIFIED IN ADVANCE IF THE COST EXCEEDS $100? □ YES □ NO

 

** PLEASE NOTE: RETAIN A COPY OF THIS REQUEST FOR YOUR FILES **

** IT IS A REQUIRED DOCUMENT IF YOU WOULD NEED TO FILE AN APPEAL **

____________________________________________________________________________

FOR AGENCY USE ONLY

 

OPEN-RECORDS OFFICER: Paul J. McCurdy, Borough Manager

 

□  I have provided notice to appropriate third parties and given them an opportunity to object to this request

 

DATE RECEIVED BY THE AGENCY:

 

AGENCY FIVE (5) BUSINESS DAY RESPONSE DUE:

 

**Public bodies may fill anonymous verbal or written requests.  If the requestor wishes to pursue the relief and remedies provided for in this Act, the request must be in writing.  (Section 702.) Written requests need not include an explanation why information is sought or the intended use of the information unless otherwise required by law.  (Section 703.)