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

Right To Know Request Form - Upper Providence Township

Upper Providence Township

Record Request Form

Date:

__________________________________

Name:

__________________________________

Address:

__________________________________

Telephone:

__________________________________

Description of record(s) requested: ________________________________________________________

_____________________________________________________________________________________

Instructions:

Pick-up

Fax

Mail

Disk

E-mail

_____________________________________________________________________________________

Signature:

__________________________________

Return this form to Upper Providence Township’s open records officer; see next page for address.

For office use only:

Copies: _______

Postage: _______

Disk: _______ Fax: _______ Clerical: _______

Total cost: __________

Date request fulfilled: ______________

Initials of staff member: ____________

Date information

Picked up: _______

Faxed: _______

Mailed: _______

Right To Know Request Form - Upper Providence Township