Bay County FOIA Coordinator
515 Center Avenue, Ste. 402
Bay City, MI 48708
(989) 895-4131; FAX: (989) 895-2094
FOIA Affidavit of Indigence
(Complete only if you are claiming that you do not have the financial resources to pay for copies of requested public records)
The undersigned, being first duly sworn, affirm under penalty of perjury that the information contained in this affidavit is true and correct
to the best of my information, knowledge, and belief. (CHECK ALL THAT APPLY):
On this date, I am receiving _________________________________________ (type) public assistance.
I am not receiving public assistance, but I am unable to pay the cost of the copies of records.
COMPLETE THE FOLLOWING:
EMPLOYER:__________________________________________________________________________________
POSITION:____________________________________________________________________________________
DEPENDANTS (STATE RELATIONSHIP): __________________________________________________________
I am making this request for records in conjunction with outside parties who are offering or providing me payment or other
compensation to make the request.
I have not previously received discounted copies of public records from Bay County twice during the calendar year.
___________________________________________
Print Name
___________________________________________ ________________________
Signature Date
Revised 1/6/2020
