FREEDOM OF INFORMATION REQUEST

 

Name: ______________________________________________________________________

 

Address: ____________________________________________________________________

 

               ____________________________________________________________________

 

Telephone number: ___________________________________

 

Records requested (please be as specific as possible) _________________________________

 

___________________________________________________________________________

 

___________________________________________________________________________

 

___________________________________________________________________________

 

___________________________________________________________________________

 

I want to examine and/or copy those records (check all that applies).

 

I understand that I may have to pay for certain copying costs or postage costs, and that I will have to pay such costs upfront before I am provided the records that I am requesting. No fees shall be charged for the first 50 pages of black and white, letter or legal sized copies requested by a requester. The fee for black and white, letter or legal sized copies shall not exceed 15 cents per page. If a public body provides copies in color or in a size other than letter or legal, the public body may not charge more than its actual cost for reproducing the records.

 

I want to pick up the requested records myself, or have the records mailed to me by

  regular U.S. Mail, or certified mail, or other means __________________________.   (check all that applies - requester must pay for any mailing costs other than regular U.S. mail)

 

I want the copies to be certified.                        

 

This request is or is not made for commercial benefit purposes (check one).

 

Other information or requests that I am seeking: ____________________________________

___________________________________________________________________________

___________________________________________________________________________

 

_________________________          _____________________________________________

Date                                                    Signature