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2. I. Contact Information
   Please provide any information necessary to address your appeal. At least one method of communication is required.
4. First Name
5. Last Name
7. Organization (if applicable)
8. Email Address
10. Address1
12. Address2
14. City
15. State
16. Zip
18. Telephone Number
19. Fax Number
21. Records Custodian Assigned
22. Request Reference Number
23. Original Request Date
27. II. Appeal Information
29. Appeal Type

    Please check all that apply.

    1. No response to Public Records Request.
    2. Incomplete response or partial fulfillment.
    3. Denial of fee reduction or waiver.
    4. Improper withholding.
    5. Additional information sought.
    6. Other (specify below)
31. Appeal Summary
33. Supporting Documentation
    Please upload any supporting documentation that you wish to have considered alongside your appeal.
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field