Freedom Of Information Act Request Form - Buena Vista Charter Township printable pdf download

BUENA VISTA CHARTER TOWNSHIP

1160 S. OUTER DRIVE  SAGINAW MI 48601-6595

PHONE: (989) 754-6536  FAX: (989) 755-7224

TDD: (989) 754-3236

Freedom of Information Act

Request Form

Costs may only be charged if a copy of a public record is requested. No fee may be charged for an

individual to simply review public records.

Date request received: __________________

Date of Response ______________

Requester’s Name________________________________________________________

Address ________________________________________________________________

City _________________________ State __________ Zip Code ___________________

Phone Number _____________________ E-Mail _______________________________

Record(s) Requested:

______________________________________________________________________________________

______________________________________________________________

Duplication Costs:

Facility used: BVCT Hall

Other:______________________

_____Township-owned copier

_____Commercial copier

Cost per copy _________x Number of copies ______ = $______________

Cost per computer disk _______ x Number of copies ______ = $________

II.

Mailing Cost:

Cost per envelop _______ x Number of envelopes _______ = $__________

Postage costs (provide brief description) _______________ = $__________

III.

Labor Costs:

Due to the nature of this request, a labor fee is being charged for the search, examination, review

and (is appropriate) the deletion and separation of exempt from nonexempt information as

provided in Section 14 of the Freedom of Information Act. This fee is being charged because the

failure to do so would result in unreasonably high costs to the Township. Specifically:

_______________________________________________________________________________

__________________________________________________________

Hourly labor rate _____________ x Number of hours ____________ = $_____________

IV.

Total Charges:________________

Requested by:____________________________

Filed by: ________________________

Freedom Of Information Act Request Form - Buena Vista Charter Township