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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.
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