Standard Right-To-Know Request Form

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2100 Corporate Drive
1-888-997-3352
TOGETHER HAPPENS HERE
Suite 500
F: 1-866-977-3527
Wexford, PA 15090
STANDARD RIGHT-TO-KNOW REQUEST FORM
DATE REQUESTED:
REQUEST SUBMITTED BY:
E-MAIL
U.S. MAIL
FAX IN-PERSON
NAME OF REQUESTER :
STREET ADDRESS
:
CITY/STATE/COUNTY/ZIP(Required):
TELEPHONE (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
FOR AGENCY USE ONLY
RIGHT TO KNOW OFFICER:
DATE RECEIVED BY THE AGENCY:
AGENCY FIVE (5) BUSINESS DAY RESPONSE DUE:
**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. (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.)

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