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.