Freedom Of Information Act Request Form
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1GREENVILLE DEPARTMENT OF PUBLIC SAFETY
MARK REISS, DIRECTOR
415 S. LAFAYETTE STREET
GREENVILLE, MICHIGAN 48838
PHONE: 616-754-9161 FAX: 616-754-0344
FREEDOM OF INFORMATION ACT REQUEST FORM
(Freedom of Information Act, Authority: MCL 15.231, et seq.)
PLEASE COMPLETE THE FOLLOWING INFORMATION
Date Requested:
Requestor’s Name:
Requestor’s Address:
Requestor’s Phone No.:
(AREA CODE/PHONE NUMBER YOU CAN BE REACHED MON – FRI 8:00a-4:30p)
SPECIFIC INFORMATION REQUESTED
(IF THE REQUEST IS UNCLEAR, IT COULD PREVENT THE DEPARTMENT FROM PROVIDING THE INFORMATION)
Date(s) of Incident(s):
Location(s) of Incident(s):
What type of incident(s)
Person(s) involved:
Name:
Date of Birth:
Name:
Date of Birth:
Name:
Date of Birth:
Name:
Date of Birth:
Relationship to you:
Police Report
Number(s) (if known):
Any additional information:
Please allow five (5) business days to process all requests. The Greenville Department
of Public Safety will notify you by phone when your request is complete. All fees are
payable upon receipt of the document(s).
Signature of Requestor:
ACKNOWLEDGMENT OF RECEIPT OF FOIA
(Do not sign until you pick up the report(s))
Signature of Requestor:
Date:
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