Standard Right-To-Know Request Form

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STANDARD RIGHT-TO-KNOW REQUEST FORM
Date Requested:
________________________________________
Name of Requestor:
________________________________________
Requestor’s Email Address: ________________________________________
Street Address:
________________________________________
City/State/Zip/County (required): __________________________________
Telephone Number (optional):
__________________________________
Records requested:
* Provide as much specific detail as possible so the Township can identify the information.
Yes
No
Do you want copies?
Do you want to inspect the records?
Yes
No
Do you want copies of records?
Yes
No
Kyle Seckinger or Chief Mark Goldberg for police records
Right-To-Know Officer:
Date request received by Township: ___________________________
Agency Five (5) 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 request need
not include an explanation why information is sought or the intended use of the information, unless
otherwise required by law. (Section 703).
Upon completion of this request, this document should be emailed to:
or
warwickpolice@comcast.net
or
, mailed to: Warwick Township
Warwick Township Police
Attn: Kyle Seckinger
or
Attn: Mark Goldberg
1733 Township Greene
1733 Township Greene
Jamison, PA 18929
Jamison, PA 18929
Standard Right to Know Request form 02/2009

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