Form Center

Freedom of Information Act Request

2. Requester's Name*

3. Date
   Date

5. Street Address*

7. City*

8. State*

9. Zip Code*

11. Telephone Number*

12. Title

14. Department*
    -- Select One --Township RecordsAssessor Records

16. Records Sought*

    Be as specific as possible.

18. Signature of Requester

20. The agency will respond to or deny a request for public records within 5 business days after its receipt.

    The agency will respond to or deny a request for public records within 5 business days after its receipt.

22. Date Response Due
    Date Response Due

23. Date Response Made
    Date Response Made

25. Copies Made

26. How Many

27. Cost

29. Time Taken to Fill Request (Hours)

31. Extension To
    Extension To

32. Extension Notice Sent
    Extension Notice Sent

    Attach copy.

33. Denied
    Denied

    Attach copy.

35. Signature of Employee Responding

Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field