Right To Know Request Form - Upper Gwynedd Township printable pdf download

Right To Know Request Form - Upper Gwynedd Township

UPPER GWYNEDD TOWNSHIP

P.O. Box 1, West Point, PA 19486

215-699-7777

Fax: 215-699-8846

STANDARD RIGHT-TO-KNOW REQUEST FORM

DATE REQUESTED:

__________________________

◯ E-MAIL

◯ US M AIL

◯ FAX

◯ IN-PERSON

REQUEST SUBMITTED BY:

NAME OF REQUESTOR:

_______________________________________________

STREET ADDRESS:

_______________________________________________

CITY, STATE, COUNTY, ZIP (Required)

__________________________________

TELEPHONE (Optional)

________________________________

RECORDS REQUESTED (Provide as much specific detail as possible so the agency can identify

the information).

____________________________________________________________________________________

DO YOU WANT COPIES?

YES __________

NO __________

DO YOU WANT TO INSPECT THE RECORDS?

YES __________

NO __________

DO YOU WANT CERTIFIED COPIES OF RECORDS? YES __________

NO __________

* * * For Agency Use Only * * *

Right-to-Know Officer: _____________________________________

Date Received by Agency:

_____________________________________

Agency Five (5) Business 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 requests need not include an explanation why information is sought

or the intended use of the information unless otherwise required by law (Section 703).

04/2010

Right To Know Request Form - Upper Gwynedd Township