RIGHT TO KNOW LAW APPEAL
DENIAL OR PARTIAL DENIAL
Office of Open Records
Commonwealth Keystone Building
400 North Street, 4
th
Floor
Harrisburg, PA 17120-0225
Fax: (717) 425-5343 E-mail: openrecords@pa.gov Today’s date: ___________________
Requester’s name: _____________________________________________________________________
Address/City/State/Zip: __________________________________________________________________
Request submitted by: □ Fax □ Mail □ E-mail □ In-Person (Please check one)
Date of Right to Know request: ________________ Date of Agency Response: ___________________
Telephone and fax number: ____________/______________ E-mail: ____________________________
Name and address of Agency: ____________________________________________________________
E-mail Address of Agency________________________________ Fax of Agency ___________________
Name and title of person who denied my request: ______________________________________________
I submitted a request for records to the agency named above. The agency either denied or partially
denied my request. I am appealing that denial to the Office of Open Records (OOR), and I am
providing the following information:
I was denied access to the following records (attach additional pages if necessary):________________
__________________________________________________________________________________
The agency’s denial of my request is flawed and the requested records are public records because
(check all that apply) (REQUIRED):
□ the records document the receipt or use of agency funds.
□ the records are in the possession, custody or control of the agency and are not protected by
any exemptions under Section 708 of the Right-to-Know Law, are not protected by
privilege, and are not exempted under any Federal or State law or regulation.
□ Other _____________________________________________________________________.
(attach additional pages if necessary)
□ I have attached a copy of my request for records. (REQUIRED)
□ I have attached a copy of all responses from the agency regarding my request. (REQUIRED)
□ I have attached any letters or notices extending the agency’s time to respond to my request.
□ I hereby agree to permit the OOR an additional thirty (30) days to issue a final order in this
appeal.
Respectfully Submitted, _______________________________________ (must be signed)
You should provide the agency with a copy of this form and any documents you submit to the OOR.
