Right-to-Know Request Form
Email address *
Date Requested: *
MM
/
DD
/
YYYY
Request Submitted by: *
Request submitted to (Agency name & address): *
Your answer
Name of Requester: *
Your answer
Street Address: *
Your answer
City/State/County/ZIP: *
Your answer
Telephone:
Your answer
Record Requested *
Provide as much specific detail as possible so the agency can identify the information.
Your answer
Do you want copies? *
Do you want to inspect the records? *
Do you want certified copies of records? *
Do you want to be notified in advance if the cost exceeds $100 *
PLEASE NOTE:
A copy of this form was emailed to the address you provided at the top of this form.

RETAIN THE EMAIL COPY OF THIS FORM FOR YOUR FILES.
IT IS A REQUIRED DOCUMENT IF YOU WOULD NEED TO FILE AN APPEAL.

A copy of your responses will be emailed to the address you provided.
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