Freedom Of Information Act Request Form/worksheet printable pdf download

Freedom Of Information Act Request Form/worksheet

FREEDOM OF INFORMATION ACT REQUEST FORM/WORKSHEET

P.A. 442 of 1974, as amended

DATE REQUEST RECEIVED:_____________________________

REQUEST RECEIVED FROM:

_______________________________ PHONE_____________________

_______________________________

PUBLIC RECORD(S) REQUESTED:

(Describe in detail the information being requested.

PLEASE BE SPECIFIC. If the request is unclear, it could prevent the City from providing the information

desired.)

________________________________________________________________

TOTAL INTERNAL COPYING COSTS AS ITEMIZED BELOW: $_______

First Page

$2.00

__________additional pages

@ .20c per page

__________computer disk(s)

@_____________per disk

_____________

________labels @ _________ea.

_____________

_____________________(other)

@__________ea

_____________

TOTAL EXTERNAL COPYING COSTS AS ITEMIZED

BELOW:$________

Vendor or facility used: __________________________

Item(s) copied ___________________

@____________ea.

_____________

III

TOTAL MAILING COSTS AS ITEMIZED BELOW:

$________

Envelope or other mailing device

_____________

Postage

_____________

ESTIMATED LABOR COSTS AS ITEMIZED BELOW:

$________

Due to the nature if this request, a labor fee is being charged for the research, examination, review

and (if applicable) the deletion and separation of exempt from nonexempt information as provided

Freedom Of Information Act Request Form/worksheet