Microsoft Word - FOIA Request form 010215 (3).doc
RECORDS MANAGEMENT SERVICES DIVISIONFREEDOM OF INFORMATION ACT REQUEST FORMDate of Request: Name: Street Address: City: State: Zip Code: Phone Number: Signature: Information Requested (please be as specific as possible – type or print clearly):FOR OFFICE USE ONLYDate FOIA Form Received:Signature of Employee Receipt: Date Receipt Response Due:Date Response Mailed to Requestor: ................
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