LRPD Freedom of Information Act Request

For Official Use Only

The remainder of the form will be completed by personnel assigned to your request.

Request Received by:

Name: Department:

Record Provided by:

Date Provided: Time Provided: Number of Copies Made:___________ Charges: $____________

Received Signature: _______________________ Date:__________

Please Note: The three day time requirement does not start until the FOI request is assigned.