Right To Know Request Form - Fairview Township printable pdf download

Right To Know Request Form - Fairview Township

FAIRVIEW TOWNSHIP, YORK COUNTY, PENNSYLVANIA

599 Lewisberry Road, New Cumberland PA 17070

Telephone 717.901.5261

Fax: 717.901.5233

REQUEST FOR EXAMINATION, INSPECTION AND/OR COPYING OF PUBLIC

RECORDS PURSUANT TO THE RIGHT-TO-KNOW LAW, ACT 3 OF 2008.

Please review the Open Records Policy on the back of this form for the examination, inspection

and/or copying of public records and complete the information on this form.

______________________________________________________________________

Name:

____________________________________________________________________

Address:

_______________________________________________________________

Telephone No.:

Specifically identify the documents you wish to examine or copy:

____________________________________________________________________________

_____________________________________________________________________________

Do you want copies of the documents you are requesting? (Circle one) Yes

Instructions:

(Circle one)

Pick-Up

Mail

Examine in Office

Signature of Requesting Party:

____________________

___________________________________

Dated:

_____________________________________________________________________________

For Office Use Only

Received by RTK Officer

(Date Stamp)

Copies___________ Postage___________

Other____________________

Date Request Completed _______________

By____________ (Staff Initials)

Date Information:

Notified:__________

Picked Up___________

Mailed____________

Total Cost: $_________________

H:\Right to Know Requests\AA OPEN RECORDS LAW REQUEST FORM 2009.doc

Right To Know Request Form - Fairview Township