MPIA Request Form

Maryland Public Information Act Request Form

Application to inspect / copy public records
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Description of Public Records Requested - Please identify specific records clearly:
Public Record Inspection / Delivery Method
For in person inspection, please list preferred dates / times:
INSPECTION & RESPONSE TIME

Requests for inspection or copying of public records are processed in accordance with the Maryland Public Information Act.

The Town of Galena will acknowledge receipt of a request within ten (10) working days and will grant or deny the request, in whole or in part, within the timeframes required by law. If additional time is needed due to the scope or complexity of the request, the requester will be notified.

FEES

There is a charge of $0.25 per single-page, black-and-white copy and $0.50 per double-sided, black-and-white copy.

Additional fees may apply for search, preparation, redaction, copying, or postage as permitted by law. If applicable, the requester will be notified of any estimated fees prior to processing. Fees may be waived or reduced if disclosure is determined to be in the public interest.

PUBLIC RECORDS FORMAT

Most Town records are maintained electronically, and limited hard copies may be available for in-person inspection at Town Hall. Records may be provided electronically or by mail upon request when available.
Signature
Title (if applicable)
Date

MonthDayYear
Date
Should be Empty:

Maryland Public Information Act Request Form