CHOCONUT TOWNSHIP

R R 1 BOX 1702

FRIENDSVILLE, PA 18818

Phone:  570-553-2780 – Fax: 570-553-2096

E-mail:  choconut@stny.rr.com

STANDARD RIGHT-TO-KNOW REQUEST FORM

DATE REQUESTED:

REQUEST SUBMITTED BY:           E-MAIL            U.S. MAIL       FAX     IN-PERSON  

NAME OF REQUESTOR :______________________________________

STREET ADDRESS         :_____________________________________________

CITY/STATE/COUNTY (Required): __________________________________________

TELEPHONE (Optional):___________________________________________________

RECORDS REQUESTED:

*Provide as much specific detail as possible so the agency can identify the information.

DO YOU WANT COPIES?  YES or NO

DO YOU WANT TO INSPECT THE RECORDS?  YES or NO

DO YOU WANT CERTIFIED COPIES OF RECORDS? YES or NO

____________________________________________________________________________

RIGHT TO KNOW OFFICER:

DATE RECEIVED BY THE AGENCY:

AGENCY FIVE (5)-DAY RESPONSE DUE:

**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.)