§ 1. REQUEST FOR PUBLIC RECORDS.

TO:                          

   FOI OFFICER

   Department

   Address

   I hereby request to inspect the following records:

   (Describe with as much particularity as possible)

   Please indicate if you wish to inspect the above captioned records or wish a copy of them:

          Inspection             Copy        Both

   Do you wish to have the copies certified?        

   I recognize that fees will be charged for the copying and/or certification of records and will pay those fees upon notification thereof and prior to delivery.

Date of Request:         

Name:                                                                         Signature

   Address

(Res. 361-84, passed 10-3-84)