Form Poor-001 - Standard Right-To-Know Request Form printable pdf download

Form Poor-001 - Standard Right-To-Know Request Form

POOR-001 (9/08)

DATE RECEIVED:

STANDARD RIGHT-TO-KNOW REQUEST FORM

DATE REQUESTED:

REQUEST SUBMITTED BY:

E-MAIL

U.S. MAIL

FAX

IN-PERSON

NAME OF REQUESTOR (Optional):______________________________________

STREET ADDRESS (Optional):_____________________________________________

CITY/STATE/ZIPCODE/COUNTY (Required): ____________________________________

TELEPHONE (Optional):___________________________________________________

E-MAIL (Optional): ________________________________________________________

RECORDS REQUESTED:

*Provide as much specific detail as possible so the agency can identify the information.

DO YOU WANT COPIES? YES or NO

DO YOU WANT TO INSPECT THE RECORDS? YES or NO

DO YOU WANT CERTIFIED COPIES OF RECORDS? YES or NO

RIGHT TO KNOW OFFICER:

DATE RECEIVED BY THE AGENCY:

***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 and the

requestor’s name and address become required. (Section 702.)

****Written requests need not include an explanation why information is sought or the intended

use of the information unless otherwise required by law. (Section 703.)

Form Poor-001 - Standard Right-To-Know Request Form