Foia Request Form - Lenawee County
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1
2Lenawee County
County:
Keep original
Request Form
and provide copy of both
Note: Requestors are not
301 N. Main Street, Adrian, MI 49221
sides, along with Public
required to use this form. The
Summary, to requestor at
Phone: (517) 264-4508; Fax: (517) 264-4512; E-Mail:
kim.murphy@lenawee.mi.us
county may complete one for
no charge.
.
recordkeeping if not used
Website:
FOIA Request for Public Records
Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq.
Request No.: __________
Date Received: ___________
Check if received via:
Email
Fax
Other Electronic Method
Date delivered to junk/spam folder: _______________
Date discovered in junk/spam folder: _______________
(Please Print or Type)
Name
Phone
Firm/Organization
Fax
Street
Email
City
State
Zip
Request for:
Copy
Certified copy
Record inspection
Subscription to record issued on regular basis
Delivery Method:
Will pick up
Will make own copies onsite
Mail to address above
Email to address above
Deliver on digital media provided by the county: ________________________________________________________________
Note: The county is not required to provide records in a digital format or on digital media if the county does not already have the
technological capability to do so.
Describe the public record(s) as specifically as possible. You may use this form or attach additional sheets:
Consent to Non-Statutory Extension of County’s Response Time
I have requested a copy of records or a subscription to records or the opportunity to inspect records, pursuant to the Michigan Freedom of
Information Act, Public Act 442 of 1976, MCL 15.231, et seq. I understand that the county must respond to this request within five (5) business days
after receiving it, and that response may include taking a 10-business day extension. However, I hereby agree and stipulate to extend the county’s
response time for this request until: ________________ (month, day, year).
Requestor’s Signature
Date
(Compl
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