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FOIA Request for Public Records
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FOIA Request for Public Records
Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq.
Name
Phone
Firm/Organization
Fax
Email
Street
City
State
ZIP
Request for
Copy
Certified Copy
Record Inspection
Subscription to record issued on regular basis
Delivery Method
Will pick up
Will make own copies onsite
Mail to address above
Email to address above
Deliver on digital media provided by the Township
Describe the public record(s) as specifically as possible.
Request for Discount: Indigence
A public record search must be made and a copy of a public record must be furnished without charge for the first $20.00 of the fee for each request by an individual who is entitled to information under this act and who: 1) Submits an affidavit stating that the individual is indigent and receiving specific public assistance, OR 2) If not receiving public assistance, stating facts showing inability to pay the cost because of indigence. . If a requestor is ineligible for the discount, the public body shall inform the requestor specifically of the reason for ineligibility in the public body's written response. An individual is ineligible for this fee reduction if ANY of the following apply: (i) The individual has previously received discounted copies of public records from the same public body twice during that calendar year, (ii) The individual requests the information in conjunction with outside parties who are offering or providing payment or other remuneration to the individual to make the request. A public body may require a statement by the requestor in the affidavit that the request is not being made in conjunction with outside parties in exchange for payment or other remuneration.
Submitting an Affidavit
I am submitting an affidavit and requesting that I receive the discount for indigence for this FOIA request.
Upload Affidavit
Request for Discount: Nonprofit Organization
A public record search must be made and a copy of a public record must be furnished without charge for the first $20.00 of the fee for each request by a nonprofit organization formally designated by the state to carry out activities under subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 and the Protection and Advocacy for Individuals with Mental Illness Act, if the request meets ALL of the following requirements: (i) Is made directly on behalf of the organization or its clients. (ii) Is made for a reason wholly consistent with the mission and provisions of those laws under section 931 of the Mental Health Code, 1974 PA258, MCL330.1931. (iii) Is accompanied by documentation of its designation by the state, if requested by the Township.
Stipulation
By checking this box, I stipulate that I am a designated agent for the nonprofit organization making this FOIA request and that this request is made Date: directly on behalf of the organization or its clients and is made for a reason wholly consistent with the mission and provisions of those laws under section 931 of the Mental Health Code, 1974 PA 258, MCL 330.1931.
Upload DOCUMENTATION OF STATE DESIGNATION
OFFICE USE ONLY
Affidavit
Affidavit Received
Discount
Eligible for Discount
Ineligible for Discount
Documentation of State Designation
Documentation of State Designation Received
Discount
Eligible for Discount
Ineligible for Discount
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