TUNKHANNOCK TOWNSHIP OFFICE OF OPEN RECORDS

STANDARD RIGHT-TO-KNOW REQUEST FORM

FAX REQUEST TO:  570-643-5469

*Please print clearly*

Date of Requested: ____________________

Request Submitted by:              EMAIL            U.S. MAIL           FAX              IN PERSON

Name of Requestor:  __________________________________________

Street Address:  _______________________________________________________

                        _______________________________________________________

Telephone (Optional):  _______________________________________________

Records Requested: *Provide as much specific detail as possible so the agency can identify the information

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Do you want copies?                 YES       NO

Do you want to inspect the records?            YES           NO

Do you want certified copies of the records?                 YES               NO       

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Right to know Officer:  Dorothy A. Trauger

Date received by the agency: _____________________________________

Agency Five (5)-day response due: ________________________________