Under Act No. 442 of the Public Acts of 1976, as amended, I am requesting the following
information. I understand that there is a fee for the requested information and I agree to
pay all fees prior to receiving copies of the requested information. I also agree to pay
50% of all fees if the cost is estimated to be $50.00 or more. I have read and agree to
the terms outlined in the City of West Branch Freedom of Information Act Policy.
I, _____________________________, have read and agree to the terms listed above.
Public record(s) requested: _________________________________________________
_______________________________________________________________________
_______________________________________________________________________
I request that I be notified at the following location when the records are ready for pick up:
Address: ________________________________________________________________
________________________________________________________________________
Phone #: _________________________________________________________________
Signature: ___________________________________ Date: _____ /_____
/___________
*************************************************************************
For office use only
I confirm that the public record(s) requested above can be reproduced. The City has received any payment required before reproducing and agrees to provide copies of the public record as requested.
Signature of FOIA Coordinator: _____________________________________________