Request for Information Form

2. Public Request No.

4. Request Submitted By

   1. Email
   2. U.S. Mail

   1. Fax
   2. In-Person

6. Name of Requestor (Optional)

   Attach business card if applicable.

8. Property Owner

   1. Yes
   2. No

10. Street Address

12. City/State/County*

14. Telephone

15. Fax

16. Email

18. Description of Requested Information

    Provide as much specific detail as possible so the Township can identify the information. If additional sheets are required they must be stapled and the total pages included below.

20. Specify Year(s) for Material Being Requested (If Applicable)

22. Do you want to inspect the records?

    1. Yes
    2. No

23. Do you want copies?

    1. Yes
    2. No

25. If Yes, Instructions for Delivery of Requested Information

27. If Yes, Instructions for Delivery of Requested Information

    1. Pick Up
    2. Fax
    3. Mail

    1. Email
    2. Disk/CD (Provided)
    3. Other

28. Explain

30. Do you want certified copies of records?

    1. Yes
    2. No

34. Date Request for Information Received
    Date Request for Information Received

35. Open Records Officer

37. 5 Business Days from Date of Receipt of Request

39. Extension Letter Mailed

    1. Yes
    2. No

40. Approval of Extension beyond 30 days

    1. Yes
    2. No

42. Date Extension Letter Provides for Fulfilling Request
    Date Extension Letter Provides for Fulfilling Request

44. Date Request Fulfilled
    Date Request Fulfilled

45. Open Records Officer

47. Request Fulfilled By:

49. Picked Up

50. Faxed

51. Mailed

52. Emailed

54. Other

56. List of Documents Required

Leave This Blank:


58. Submit

* indicates a required field