Right to Know Request

Date of Request

Submission Method

Requesting Party Information

Name:

Phone Number

Records Requested:

* Provide as much specific details as possible so the agency can identify the information being requested. (This form is not for Motor Vehcile Accident Reports)

Department

Summary of Request

Attach /Upload File(s)

Click Here to Upload

Do you want additional copies?

Do you want to inspect the records?

Yes

Do you want certified copies of records ? (Additional fees may apply)

Yes

**Public bodies may fill anonymous verbal or written requests. If the requestor wishes to pursue the relief and remedies provided for in this Act, the request must be in writing. (Section 702.) Written requests need not include an explanation why information is sought or the intended use of the information unless otherwise required by law. (Section 703.)

ORR Form.doc

Fees for duplication by photocopying, printing from electronic media or microfilm, copying onto electronic media, transmission by facsimile or other electronic means and other means of duplication shall be assessed as authoruized by the Pennsylvania Right to Know Law, Act 3 of 2008

Right to Know Officer Chris Lucco, City Administraor

Receipt

You will be provided with a Receipt upon submission.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Date Recieved by Agency: _________________________

Agnecy Five (5) Day Response Due: _________________________

Fee: $_________________

Notified by: ___________________ Date_________________________