Millerstown Borough
RIGHT-TO-KNOW-REQUEST FORM
DATE REQUESTED:
REQUEST SUBMITTED BY: E-MAIL U.S. MAIL FAX IN-PERSON
Name of REQUESTER: _____________________________________________
STREET ADDRESS: _________________________________________________
CITY/ STATE/ COUNTY:______________________________________________
TELEPHONE: _______________________________________________________
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: Karen Knellinger
DATE RECEIVED BY THE AGENCY:
AGENCY FIVE (5) – DAY RESPONSE DUE: