pennsylvania OFFICE OF OPEN RECORDS Standard Right-to-Know Law Request Form Good communication is vital in the RTKL process. Complete this form thoroughly and retain a copy; iti is required should an appeal be. necessary. You have 15 business days to appeal after a request is denied or deemed denied. SUBMITTED TO AGENCY NAME: Date of] Request:. PERSON MAKING REQUEST: Name: Mailing Address: City: Telephone: (Attn: AORO) Submitted via: D Email DU.S.Mail OF Fax OInk Person Company (ifapplicable): State:. Zip:. Email: Fax: How do you prefer to be contacted ift the agency has questions? Telephone D Email D U.S. Mail RECORDS REQUESTED: Be clear and concise. Provide as much specific detail as possible, ideally including subject matter, time frame, and type of record or party names. Use additional sheets if necessary. RTKL requests should seek records, not ask questions. Requesters are not required to explain why the records are. sought or the intended use of the records unless otherwise required by law. DO YOU WANT COPIES? D Yes, electronic copies preferred ifa available D Yes, printed copies preferred D No, in-person inspection ofr records preferred (may request copies later) Do you want certified copies? D Yes (may be: subject to additional costs) ON No RTKL requests may require payment or prepayment off fees. See the Official RTKL Fee Schedule for more details. Please notify me iff fees associated with this request will be more than D $100 (or) 0$ ITEMSI BELOW THISI LINE FOR AGENCY USE ONLY Tracking: Date Received: Response Due (5 bus. days): Actual Response Date: 30-Day Ext.? D Yes D No (IfYes, Final Due Date: Request was: DG Granted D Partially Granted & Denied D Denied Cost tol Requester:$ Appropriate third parties notified and given an opportunity to object to the release of requested records. NOTE: In most cases, a completed. RTKL request form is a public record. More information about the RTKL is available at tps/www.openvecors pa.gov Form updated Nov. 27,2018