Open Records Request Form - City Of Chester printable pdf download

Open Records Office

1 Fourth Street

Chester, PA 19013

Fax: 610-447-7755

OPEN RECORDS REQUEST FORM

Name: _____________________________________________

Date Requested: ____/____/____

Request Submitted by (please check one): ___ Email

___ US Mail

___ Fax

___ In-person

Street Address: ______________________________________________________________________

City/State/Zip/County: ________________________________________________________________

Telephone: ___________________________________

Email:_____________________________

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 OR NO

DO YOU WANT TO INSPECT THE RECORDS ON SITE? YES OR NO

DO YOU WANT CERTIFIED COPIES OR RECORDS?

YES OR NO

(Certification fee may apply)

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

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

DOCUMENT IN YOU WOULD NEED TO FILE AN APPEAL **

___________________________________________________________________________________________

FOR AGENCY USE ONLY

RIGHT TO KNOW OFFICER:

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 to include an explanation

why the information is sought or the intended use of the information unless otherwise required by law. (Section 703)

Open Records Request Form - City Of Chester