Foia Request Form For Public Records - Washington Township
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1
2Charter Township of Washington, Macomb County
Township: Keep original and
Request Form
provide copy of both sides,
Note: Requestors are not
57900 Van Dyke
along with Public Summary,
required to use this form. The
Washington, Michigan 48094
to requestor at no charge.
Township may complete one
Phone: (586) 786-0010
for recordkeeping if not used.
Fax: (586) 677-4238
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: _______________
Name
Phone
Firm/Organization
Fax
Street
Email
City
State
Zip
Date discovered in junk/spam folder: _______________
(Please Print or Type)
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 Township: ________________________________________________________________
Note: The Township is not required to provide records in a digital format or on digital media if the Township 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 Township’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 Township 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
Township’s response time for this request until: ________________ (month, day, year).
Requestor’s Signature
Date
(Complete both sides)
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