Record Request Form printable pdf download

Record Request Form

MILLCREEK TOWNSHIP

3608 West 26th Street

Erie, PA 16506-2037

RIGHT-TO-KNOW ACT REQUEST FORM

DATE REQUESTED____________________________________________________

REQUEST SUBMITTED BY ____E-MAIL ____U.S. MAIL ____FAX ____IN-PERSON

NAME OF REQUESTER

_____________________________________________________________________

STREET ADDRESS

____________________________________________________________

CITY/STATE/COUNTY

__________________________________________________

TELEPHONE (Optional)

____________________________________________________________

RECORDS REQUESTED:

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

The Township will not identify unspecified records or conduct research for a requestor.

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

______________________________________________________________________

Record Request Form