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2. Request Submitted By

   1. Email
   2. U.S. Mail

   1. Fax
   2. In-Person
4. Name of Requester (Optional)

   Attach business card if applicable.

6. Property Owner

   1. Yes
   2. No
8. Street Address
10. City/State/County*
12. Telephone
13. Fax
14. Email
16. Records Requested

    Be clear and concise. Provide as much specific detail as possible, ideally including subject matter, time frame, and type of record or party names. RTKL requests should seek records, not ask questions. Requesters are not required to explain why the records are sought or the intended use of the records unless otherwise required by law.

18. Specify Year(s) for Material Being Requested (If Applicable)
20. Do you want to inspect the records?

    1. Yes
    2. No
21. Do you want copies?

    1. Yes
    2. No
23. If Yes, instructions for delivery of requested records

    1. Pick Up
    2. Fax
    3. Mail

    1. Email
    2. Disk/CD (Provided)
    3. Other
24. Explain
26. Do you want certified copies of records?

    1. Yes
    2. No
28. Request Fulfilled By:

30. We will provide you the records requested or a notification that your request has been denied within five business days. 

    Please allow five business days from the date that you submit the form before following up on your request with us.

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:

    1. Jennifer Keller
    2. Yvette Johnson
    3. Lee Benson
    4. Mimi Gleason
49. Picked Up
50. Faxed
51. Mailed
52. Emailed
54. Other
56. List of Documents Required
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field