Freedom Of Information Act Request Form/worksheet (Page 2 of 2) in pdf

in the City of Kentwood FOIA Policy. This fee is being charged due to unusually high costs to the

City because of:

___________________________________________________________

_____________Estimated Labor Hours

@____________per hour, including benefits _____________

REGULARLY PUBLISHED PUBLIC RECORD:

May be issued for up to six months (renewable). Requires a $25 deposit fir the costs of copying

and mailing.

Escrow Deposit ($25.00)

__________________

TOTAL COSTS OF ITEMS I-VI ABOVE

(Where Estimated Total Costs Exceed

$50.00, a deposit just be paid in advance).

$____________________________

Please make check payable to City of Kentwood, and mail to P.O.

Box 8848, Kentwood, MI 49518

And return to the attention of the City Clerk

rev. code __CM

I, ______________________________, am requesting copies under FOIA. Based on the City

of Kentwood’s approved FOIA Police, I am submitting 50% of the estimated TOTAL COSTS

as required, and confirm that the balance of the fees incurred will be paid before the public

record(s) are released to me.

SIGNATURE_______________________________________DATE_______________________

The public record(s) requested shall be available, unless otherwise exempted, within five (5)

business days of the City’s receipt of this confirmation. Under unusual circumstances, the City may

request an extension of ten (10) days to provide the information requested.

REASON FOR EXTENSION

________________________________________________________________

VII

DENIAL OF RECORDS

The City of Kentwood denies your request because:

_______The requested public record is exempt from disclosure in accordance with the Act

_______The requested public record does not exist under the name given by the person or

another name reasonably known to the public body.

_______The following information had to be separated or deleted from the public record

pursuant to the City of Kentwood FOIA Policy:

_______________________________________________________________________

Signature___________________________________________________Date_______

VIII

APPEALS

You have the right to appeal the denial of your request for a public record. The appeal must

be in writing to the City Commission identifying the reason(s) for the denial. Within ten (10) days

after receiving the written appeal, the City Commission shall reverse the denial, uphold the denial, or

reverse in part/uphold in part. Under unusual circumstances, the City Commission may extend the

response period for up to ten (10) business days.

Freedom Of Information Act Request Form/worksheet Page 2

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