Open Records Policy And Request Form (Page 4 of 4) in pdf

Open Records Policy And Request Form Page 4

Number Assigned to Request:

(For Borough Use ONLY)

OPEN RECORD REVIEW/DUPLICATION REQUEST

Date of Request: ______________

Please Print Legibly…

Requester’s Name:

____________________________________________________

Requester’s Address: ____________________________________________________

_____________________________________________________________________

Requester’s Telephone: __________________________________________________

I request

review

duplication (check applicable box) of the following records:

(IMPORTANT - You must identify or describe the records with sufficient specificity to enable the Administration of the

Borough to determine which records are being requested. Use additional sheets if necessary. The cost for copies is

25¢ per page. Requests for 40 pages or more must be paid in advance.)

______________________________________________________________________

_______________________________________________________________________

______________________________

Signature of Requester

This request may be submitted in person, by mail, email or by facsimile to:

Karen L Scherer, Open Records Officer

Phone: 610.444.6020

Borough of Kennett Square

Fax:

610.444.9385

120 Marshall Street

Kennett Square PA 19348

(This portion to be completed by Borough of Kennett Square personnel ONLY)

Date Request Received:

Approved or Denied (circle one):

(Initial and Date)

Department Assigned to:

Date:

Date and Time Requestor Contacted:

By:

Date Records Reviewed by Requestor:

By:

(Limited to 30 days from date of contact)

Completed form must be returned to the Borough’s Office of Open Records…Thank You!

Revised December 9, 2014

Open Records Policy And Request Form Page 4