Foia Request Form - Emmet County
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1
2Emmet County
200 Division St
, Suite G70
Petoskey, Michigan 49770
Phone: (231) 348-0678
FOIA REQUEST FOR PUBLIC RECORDS
Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq.
Print or Type:
Name:
Phone:
Firm/Organization:
Fax:
Street:
Email:
City/State/Zip:
Request for: Copy
Certified Copy
Record Inspection
Subscription to record issued on regular basis
Delivery Method:
Will pick up
Mail to address above
Email to address above
Deliver on digital media provided by the County.
Note: The County is not required to provide records in a digital format or on digital media if the County does not already have the
technological capability to do so.
Describe the public record(s) as specifically as possible. You may use this form or attach additional sheets.
Consent to Non-Statutory Extension of County’s Response Time
I have requested a copy of records or a subscription to records or the opportunity to inspect records, pursuant to the
Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq. I understand that the County must
respond to this request within 5 business days after receiving it, and that response may include taking a 10 business
day extension. However, I hereby agree and stipulate to extend the County’s response time for this request until:
(month, day, year).
Requester’s Signature
Date
For Office Use Only:
Request No. _____________________
Date Received: ____________________
Via:
Mail
In Person
Fax
Email
Other Electronic Method
Junk/Spam Folder:
Date Delivered ____________
Date Discovered ___________
County: Keep original and provide copy of both sides,
Note: Requesters are not required to use this form. The
along with Public Summary, to requester at no charge.
County may complete one for recordkeeping if not used.
(Complete both sides)
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