Freedom Of Information Act Request Form printable pdf download

Freedom Of Information Act Request Form

FREEDOM OF INFORMATION ACT REQUEST FORM

To be completed by person originating request:

Name:___________________________________________________________________

Address:__________________________________________________________________

City:_____________________________________________________________________

Name of Business:__________________________________________________________

Home Phone:______________________________________________________________

Office Phone:______________________________________________________________

I request to obtain the information in the following format:

___ Visual Inspection

___ Photocopies

___ Diskette (if applicable)

___ Printed Lists (if applicable)

___ Printed Labels (if applicable)

I request the following specific records or information:

__________________________________________________________________________

I understand that this request for information will be responded to within five (5) working days.

I understand that the City may charge fees to cover the cost of providing this information.

______________________________________

__________________

Signature

Date

______________________________________________________________________________

DISPOSITION OF REQUEST

_____ Approved

_____ Denied - Information requested is exempt under Freedom of Information Act, Section 13

_____ Denied – A portion of the information requested is exempt from disclosure under

Freedom of Information Act, Section 13; the non-exempt material was provided.

_____ Denied – Material requested does not exist.

Person handling request:

Name:______________________________________

Date:________________________

Signature

Freedom Of Information Act Request Form