Records Request Form - Town Of Greenwich
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1Town of Greenwich
101 Field Point Road
Greenwich, CT 06830
203-622-7700
RECORDS REQUEST FORM
You may use this form to request copies of public records from Town agencies, boards, departments, and
divisions. Although any written request for records may be submitted, , use of this form is encouraged to
ensure that you can be provided with the correct records as quickly as possible. Please write legibly.
Separate forms should be used to request Geographic Information Systems (GIS) maps, data, abutters,
and data layers.
1. Name: ________________________________________ Phone: _(_______)__________________
Mailing address: __________________________________________________________________
2. Office/Department from which records are sought: ______________________________________
3. Please provide me with copies of the following records (continue on back if necessary):
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check here for certified copies
4. Please provide me with any such electronically-stored records in the following format:
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printout
computer diskette
other: _________________________________________
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5. When the records are ready, please:
mail them to me OR
call me for pickup
OFFICIAL USE ONLY
* = prior authorization of Town Law Department is required
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date request was received: ______________
date of status letter to requestor: _________________
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date copies were mailed or requestor was called for pickup: ______________
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fee charged in advance ($10 or more) or
fee billed at delivery:
$______ for photocopies of ______ pages at $0.50 each
$______ for ______ diskettes or other data storage device (specify): __________________________
$______ salary for ____ employee hours necessary for computer reformatting/reprogramming*
$______ fees of outside contractor necessary for copying/retrieval of electronic data*
= $______ TOTAL
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requestor notified by letter dated _________________ that any record will not be provided because:
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record does not exist or could not be located after thorough search
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electronic data could not be provided in requested format*
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exempt from disclosure because:* ___________________________________________________
Bridgeport/70805.2/AJC/622378v1
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