Public Records Request Appeal Form

Please provide any information necessary to address your appeal. At least one method of communication is required.

Name(Required)

First Last

Organization (if applicable)

Email Address(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Telephone Number(Required)

Fax Number

Records Custodian Assigned

Request Reference Number

Original Request Date(Required)

Appeal Type(Required)

No response to Public Records Request.

Incomplete response or partial fulfillment.

Denial of fee reduction or waiver.

Improper withholding.

Additional information sought.

Other (specify below)

Please check all that apply.

Appeal Summary

Include explanation of the circumstances surrounding the appeal.

Supporting Documentation

Drop files here or

Accepted file types: pdf, doc, docx, txt, odf, jpg, png, odt, rtf, wpd, wpf, Max. file size: 20 MB, Max. files: 5.

Please upload any supporting documentation that you wish to have considered alongside your appeal.

Receive a copy of this form.

Yes

Email(Required)

CAPTCHA