Revised Mar. 11, 2020 1
Public Information Act (PIA) Records Request Form
All requests for records maintained by the City of Annapolis pursuant to the Maryland Public Information Act should be
submitted on this form. Please type or print.
Individual Name Date
Business/Organization Name
Mailing Address
City State Zip
Phone Numbers
Email Address
Describe or identify the records that you want to inspect or copied in as much detail as possible.
The City of Annapolis charges a fee of 25¢ per page for copies of documents. There is no copy fee charged for requests
of fewer than 10 pages. There may also be a fee of $30.00 per hour for retrieval and review of the records if the retrieval
and review take more than 2 hours. In the case of an unusually large expense, prepayment may be required in advance.
I am willing to pay all fees for this request without prior notification.
I am willing to pay fees for this request up to a maximum of $
If you estimate that the fees will exceed this limit, please contact me at the email address above.
I am requesting that fees be waived on the following grounds:
Have you submitted related requests to any other City Departments? Yes No
If yes, please identify your request(s): __________________________________________________________________
A “person in interest” is a person who is the subject of the record, that person’s designee, or that person’s parent or legal
representative if the person has a disability. Under law, certain records that would not otherwise be available may be
available to a “person in interest.” At your option, you may indicate if you are a “person in interest.”
Are you a “person in interest?” If yes, please explain below. Yes No
Does any part of this request relate to any City-owned building or property? Yes No
Signature Date
City of Annapolis
160 Duke of Gloucester Street
Annapolis, MD 21401
www.annapolis.gov/recordrequest
List all City departments that this request or any similar requests are being submitted to.
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