Access/Correction Request Form
Municipal Freedom of Information &
Protection of Privacy Act
A $5.00 application fee must accompany each request for information.
Cheques or money orders should be made payable to the Regional Municipality of Halton.
No fee applies for correction request.
Request for:
Access to
general records
Access own
personal information
Access to other’s personal
information by authorized party
Correction of own
personal information
Requester’s Information
Last Name First name Middle Name
Mailing Address (Street/Apt. No./P.O. Box No./R.R. No.) City/Town
Province Postal Code Telephone No.: E-mail (optional):
Detailed description of requested records, personal information records, or records to be corrected.
Note: If you are requesting a correction of personal information, please indicate the desired correction and, if
appropriate, attach any supporting documentation. You will be notified if the correction is not made and you may
require a statement of disagreement be attached to your personal information.
Preferred method of access to records: Examine Original Receive Copy
Signature
Date
mm/dd/yyyy
For Institution Use Only
Date Received
mm/dd/yyyy
Comments
Request No.
Personal Information contained on this form is collected pursuant to the Municipal Freedom of Information
and Protection of Privacy Act and will be used for the purpose of res
ponding to your request. Questions about
this collection can be directed to the Freedom of Information and Privacy Coordinator, Clerk’s Office, Halton
Region, 1151 Bronte Road, Oakville, ON L6M 3L1, 905-825-6000, or toll free 1-866-442-5866, ext. 7252.
