Date Requested:*

Name of Requester:*

Company (if applicable):

Street Address:

City/State/Zip Code:*

County:*

Telephone:*

Email:*

How do you prefer to be contacted if the agency has questions? ?*

Phone Email

US Mail

RECORDS REQUESTED: Be clear and concise. Provide as much specific detail as possible, ideally including subject
matter, time frame, and type of record or party names. RTKL requests should seek records, not ask questions. Requesters
are not required to explain why the records are sought or the intended use of the records unless otherwise required by law.
Use additional pages if necessary.*

Do you want copies?*

Yes, electronic copies preferred if available Yes, printed copies (see fee schedule) No, in-person inspection of records preferred (may request copies later)

Do you want to inspect the Records?

Yes No

Do you want certified copies of Records?
RTKL requests may require payment or prepayment of fees. See the Official RTKL Fee Schedule for more details.*

Yes (may be subject to additional costs) No

Please notify me if fees associated with this request will be more than $100:

Yes

No

**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.)

More information about the RTKL is available at https://www.openrecords.pa.gov