Thorndale Fire Company Fireman's Relief Right-to-Know Request Form

Please read carefully. Complete this form and retain a copy of both pages; this copy may be required if an appeal if filed. You have 15 business days to appeal after a request is denied or deemed denied. More information about the RTKL is available at https://www.openrecords.pa.gov. In most cases, a completed RTKL request form is a public record.

Indicates Required Field

Date of Request

Date the request is being submitted

Submitted via

How the request was received

Email U.S. Mail Fax In Person

Requester Information

Name of Requester

First and Last name of person submitting the request form.

Organization (If applicable)

If the person is associated with a specific organization that is requesting the information.

Mailing Address

Where to mail the information to if copies are being requested

City, State, Zip Code

City, State and Zip Code for mailing any information requested

Telephone Number

Phone number of person submitting the request in case contact is needed for additional information

Records Requested

Identify Records Being Requested

Identify records being requested with as much specificity as possible. Relevant subject matter, date range, names and any other details that will help locate the records. Requests are for seeking records, not answers to questions.

Preferred Access/Delivery

Method of receiving records

Method by which you wish to obtain the records

Inspect Records in Person Paper Copies Electronic Copies (if available) Certified Copies (may incur additional cost

Delivery Method

How do you want to receive the records requested?

Email U.S. Mail Pickup

Fees For Record Requests

Cost of Providing Records = $50.00

Cost of providing records is $50.00 but could exceed that amount depending on the number of records. Payment must be received prior to obtaining records.

I want to be notified if cost exceeds $50.00.

Requester Affirmation

Requester Affirms Information Accuracy

Check box to affirm requester information. Note that failure to check the box may result in denial of request and dismissal of any appeal filed with the Office of Open Records.

By checking this box, I affirm the name and contact information provided are true and correct to the best of my knowledge.

Signature

Submitter signature for requesting information

Agency Information

Retain a copy of both pages of this form

Submit