Fillable A35 Btpd Rtk Request Form 06-16

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A35 Btpd Rtk Request Form 06-16

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06/16 A-35
Bensalem Township Police Department
RIGHT-TO-KNOW REQUEST FORM
DATE REQUESTED:
REQUEST SUBMITTED BY: E-MAIL U.S. MAIL FAX IN-PERSON
NAME OF REQUESTOR:
STREET ADDRESS:
CITY/STATE/COUNTY (Required):
TELEPHONE (Optional):
RECORDS REQUESTED: *Provide as much specific detail as possible so the agency can identify the information.
DO YOU WANT COPIES? YES NO
DO YOU WANT TO INSPECT THE RECORDS? YES NO
DO YOU WANT CERTIFIED COPIES OF RECORDS? YES NO
____________________________________________________________________________________
RIGHT TO KNOW OFFICER:
DATE RECEIVED BY THE AGENCY:
AGENCY FIVE (5)-DAY RESPONSE DUE:
IF IN PERSON, INFORMATION RECEIVED BY: DATE:
**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.)
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A35 Btpd Rtk Request Form 06-16

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Completed 11 July 2020

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