Submitted to Agency Name * DATE REQUESTED: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 REQUEST SUBMITTED BY * Email Mail Fax In person NAME OF REQUESTOR * STREET ADDRESS * CITY/STATE/ZIP * TELEPHONE * EMAIL * de as much specific detail as possible so the agency can identify the information. * DO YOU WANT COPIES? * Yes, printed copies (default if none are checked) Yes, electronic copies preferred if available No, in-person inspection of records preferred Do you want certified copies? * Yes (may be subject to additional costs) No RTKL requests may require payment or prepayment of fees. Leave this field blank
