City Clerk’s Office
Richard M. Steenland
29777 Gratiot, Roseville, MI 48066
Phone: 586-445-5443
Fax: 586-774-8048
FOIA Request for Public Records
Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq.
REQUESTOR’S CONTACT INFORMATION REQUIRED
(Please Print or Type)
Requestor’s Signature Date
Request for: Copy of Public Records View Public Records
Delivery Method: Will pick up Mail Email Fax
*Delivery Options may very upon request.
Describe the public record(s) as specifically as possible. You may use this form or attach additional sheets:
For Office Use Only
Request No.: _____________ Date Received: ____________ Received Via Email Fax
Date discovered in junk/spam folder: _______________ Date delivered to junk/spam folder: ____________
Completed: _______________ No Record Found: _______________ Extension Sent: _______________
Initials
Date
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Name Phone
Firm/Organization Fax
Street City State / Zip Code
Email