Worcester Township Right-to-Know Law Request Form

Please read carefully. Complete this form and retain a copy of both pages; this copy may be required if an appeal is 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.

SUBMITTED TO AGENCY NAME:

Date Request Submitted:

Date

Submitted via:

Full Name

Company (if applicable):

Please send response via:

Email:

example@example.com

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Telephone:

Format: (000) 000-0000.

How do you prefer to be contacted if the agency has questions?

By checking this box, I affirm that my full name and contact information is true and correct, and that I am a legal resident of the United States. I understand that failure to check this box may result in the denail of my request and the dismissal of any appeal filed with the the Office of Open Records.

RECORDS REQUESTED: Provide as much detail as possible, including subject matter, time frame, and type of record sought. RTKL requests must seek records, not ask questions. Use additional pages if necessary.

Form continues on page 2. Retain a copy of both pages.

Standard Right-to-Know Law Request Form

PERSON MAKING REQUEST:

ITEMS BELOW THIS LINE FOR AGENCY USE ONLY