STANDARD RIGHT-TO-KNOW REQUEST FORM
DATE REQUESTED: _________________
REQUEST SUBMITTED BY: E-MAIL U.S. MAIL FAX IN-PERSON
REQUEST SUBMITTED TO (Agency name & address):__________________________________________
________________________________________________________________________________________
NAME OF REQUESTER :___________________________________________________________________
STREET ADDRESS:_______________________________________________________________________
CITY/STATE/COUNTY/ZIP(Required): ________________________________________________________
TELEPHONE (Optional):_____________________ EMAIL (optional):_____________________________
RECORDS REQUESTED: *
Provide as much specific detail as possible so the agency can identify the information.
Please use additional sheets if necessary
DO YOU WANT COPIES? YES or NO
DO YOU WANT TO INSPECT THE RECORDS? YES or NO
DO YOU WANT CERTIFIED COPIES OF RECORDS? YES or NO
** PLEASE NOTE:
RETAIN A COPY
OF THIS REQUEST FOR YOUR FILES **
** IT IS A REQUIRED DOCUMENT IF YOU WOULD NEED TO FILE AN APPEAL **
____________________________________________________________________________
FOR AGENCY USE ONLY
RIGHT TO KNOW OFFICER:
DATE RECEIVED BY THE AGENCY:
AGENCY FIVE (5) BUSINESS DAY RESPONSE DUE:
**Public bodies may fill anonymous verbal or written requests. If the requestor wishes to pursue the relief and remedies
provided for in this Act, the request must be in writing. (Section 702.) Written requests need not include an explanation
why information is sought or the intended use of the information unless otherwise required by law. (Section 703.)
