West Virginia Secretary Of State Foia On-Line Database Access Form printable pdf download

West Virginia Secretary Of State Foia On-Line Database Access Form

WEST VIRGINIA SECRETARY OF STATE

FOIA ON-LINE DATABASE ACCESS FORM

User ID chosen when account was created________________________________________________________

Agency/Governmental Body___________________________________________________________________

Name __________________________________________________ Phone _____________________________

Agency Address______________________________________ City ______________________ Zip __________

E-mail _________________________________________ Title _______________________________________

Submission of this completed form allows the above-named user to access the Freedom of Information Act online

database (FOIA db) created and maintained by the West Virginia Secretary of State. Entry of information into the FOIA

db is strictly for the purposes of complying with W.Va. State Code §§29B-1-3 and 29B-1-3a, and W.Va. 153 CSR 52. The

above-named user is granted permission by the agency, as shown by the signature below, to enter data into the FOIA db

on behalf and under the instruction of the agency.

_________________________________________

_______________________________________

FOIA Database User Signature

Date

_________________________________________

_______________________________________

Authorized Agency Signatory (Printed)

Title

_________________________________________

_______________________________________

Authorized Agency Signatory (Signature)

Date

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West Virginia Secretary Of State Foia On-Line Database Access Form