Town Of Bloomsburg Columbia County Pennsylvania printable pdf download

Town Of Bloomsburg Columbia County Pennsylvania

TOWN OF BLOOMSBURG

Columbia County, Pennsylvania

RIGHT‐TO‐KNOW REQUEST FORM

PLEASE PRINT LEGIBLY

DATE OF REQUEST: _____________________

REQUEST SUBMITTED BY:

E‐MAIL

U.S. MAIL FAX

IN‐PERSON

NAME OF REQUESTER: _______________________________________________________________

STREET ADDRESS: ___________________________________________________________________

CITY, STATE, ZIP: ____________________________________________________________________

TELEPHONE: ____________________________ EMAIL: ____________________________________

RECORDS REQUESTED:* IMPORTANT: You must identify or describe the records with sufficient specificity to enable the

Town to identify the information being requested. Please use additional sheets if necessary.

__________________________________________________________________________________________________

DO YOU WANT COPIES? YES or NO

DO YOU WANT TO INSPECT THE RECORDS? YES or NO

REQUESTER SIGNATURE: __________________________________________

This request may be submitted in person, by mail, email or facsimile to:

Tracy Lanzafame, Agency Open Records Officer

Town of Bloomsburg

Town Hall

301 E. Second Street

Bloomsburg, PA 17815

Fax Number: (570) 784‐1518

Email: tlanzafame@bloomsburgpa.org

FOR TOWN USE ONLY:

Date Received: _____________ Five (5) Business Day Response Due Date: ________________

Fees Due: _______________ Fees Received On: _________________ Request Complete by: ________________

Town Of Bloomsburg Columbia County Pennsylvania