Right To Know Request Form - Clarks Green Borough

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Clarks Green Borough
104 N. Abington Road
Clarks Green, PA 18411
Office Hours: 9:00 AM – 3:00 PM
RIGHT-TO-KNOW REQUEST FORM
DATE REQUESTED:____________(Format: 00/00/0000) Time:_______AM/PM (Indicate)
REQUEST SUBMITTED BY: ____ E-MAIL ____U.S. MAIL ____FAX ____IN-PERSON
NAME OF REQUESTOR:_________________________________________________
STREET ADDRESS:______________________________________________________
CITY/STATE/COUNTY (Required):_________________________________________
TELEPHONE:____________________________________________________________
RECORDS REQUESTED:
*Provide as much specific detail as possible to better serve you. Use dates as specifically as possible. Use
back of form if necessary.
DO YOU WANT COPIES? YES or NO (Cost for copies is $.25/each side of 8.5 x 11)
COPIES MUST BE PAID FOR IN ADVANCE.
DO YOU WANT TO INSPECT THE RECORDS? YES or NO
(At requestor’s expense)
DO YOU WANT CERTIFIED COPIES OF RECORDS? YES or NO
RIGHT TO KNOW OFFICER: Borough Secretary
DATE/TIME RECEIVED BY CLARKS GREEN:__________________
Staff Initials_______
BOROUGH FIVE (5) DAY RESPONSE DUE:______________________________________
REQUEST COMPLETED:
DATE: ____________ TIME: ___________ NUMBER OF COPIES: ______________
COST: _________ RECEIVED BY: ___________
COPIES SENT VIA: US MAIL: ____ FAX: ____ PICK-UP: ____
**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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