Foia

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

CITY OF SOUTH BEND - SOUTH BEND POLICE DEPARTMENT ACCESS TO PUBLIC RECORDS REQUEST

NAME OF REQUESTING PARTY ADDRESS OF REQUESTING PARTY PHONE NUMBER DATE OF REQUEST TIME

SIGNATURE OF REQUESTING PARTY INFORMATION REQUESTED: (Please be specific. Use back of this form if additional space is needed.)

Requesting party requests

to inspect or

to buy copies (Check One) of the information being requested.

DEPARTMENT HAVING INFORMATION REQUESTED (If known): ALL DECISIONS AS TO DISCLOSABILITY MUST BE MADE AND THE REQUESTING PARTY ADVISED OF SAME WITHIN 24 HOURS AFTER THE REQUEST IS RECEIVED.

INTER OFFICE USE ONLY


Employee Handling Request: ____________________________________________ Open Case: Yes _____ No _____ N/A _____

DECISION BY CITY ATTORNEYS OFFICE: INFORMATION DISCLOSABLE: INFORMATION NONDISCLOSABLE: ATTORNEY COMMENTS: SIGNATURE OF CITY ATTORNEY: DATE OF DECISION:

Informed Requesting Party that information is: DISCRETIONARY DISCLOSURE Date: Signature:

NONDISCLOSABLE

You might also like