Pennsylvania  Office of Open Records  Standard Right-to-Know Law Request Form  Please read carefully. Complete this form andi retain a copy ofboth pages; this copy may be requiredif an appealisfiled. You have 15 businessdays to appealafterar requetidmlelordema. denied. More information about the RTKL is available at https//www.openrecordspa.gov. In most cases, a  completed RTKL request form is a public record.  SUBMITTED TO. AGENCYNAME: Date Request Submitted: PERSON MAKING REQUEST: Full Name: Company (ifapplicable):  (Attn: AORO)  Submitted via: D Email U.S.Mail a Fax oIn Person  Please send response via: D Email oU U.S. Mail  Ifyou wish to obtain records that only exist in hard copy, or must be provided on an electronic storage device,  you may be required toj provide a mailing address to the agency. See Section 703.  Email: Mailing Address: City:  State:  Zip:  Telephone:  How do you prefer to be contacted ifthe agency has questions? D Telephone D Email 0 U.S. Mail DBy checking thisb box,Iaffirm thatmy full name and contactinformation is true and correct, and thatIam a legal resident oft the United States. lunderstand that failure to check this box may result in the denial ofr my request and the dismissal ofany appeal filed with the Officeof RECORDS REQUESTED: Provide as much detail as possible, including subject matter; time frame, and type of record: sought. RTKL requests must: seek records, not ask questions. Use additional pages ifnecessary.  Open Records.  Form continues on page. 2. Retain a copy of both pages.  1of2    RECORDS REQUESTED (continued):  DO YOU WANT COPIES? OYes, printed DY Yes, electronic 0 No, in-person inspection Records. shall be provided in the medium requested ifthey exist in that medium; otherwise, they shall be provided in the medium in which they exist. See. Section 701. Your request may require payment or lunderstand that my request mayi incur fees. Notify me before further processing iff fees will  prepayment offees. View the Official RTKL Fee Schedule for more details.  be more than D $100 (or) o$  Doy you want certified copies? D Yes (may be: subject to additional costs) 0 No  ITEMS BELOW THIS LINE FOR AGENCY USE ONLY  Tracking:  Date Received:  Response Due (5 bus. days): ) Actual Response Date:  30-Day Ext.? DYes D No (IfYes, Final Due Date:  Request was:  Granted  Partially Granted & Denied  Denied Cost to Requester:  $  - Appropriate third parties notified and given an opportunity to object to thei release ofr requested records.  Retain a copy of both pages ofthis Form.  2of2