Maryland Public Information Act (MPIA) Request Form
Requestor Information
Assigned MPIA Request #
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Name
*
First Name
Last Name
Organization/Department Name
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Best time/Method to Contact
*
Target Information
BDC Division(s) Record Request
*
Business Development
Finance
Innovation
Operations
Real Estate
Strategy & Knowledge Managment
Preferred Format
*
PDF/Electronic Document(s)
Paper Document(s)
Preferred Method of Delivery
*
Email
U.S. Mail
In-Person Pick up
Title or Type of Records Requested
*
(e.g., contracts, memos, emails, reports, plans, etc.)
Detailed Description
*
Purpose of the Request
*
Back
Next
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Relevant Information Timeframe
From:
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To:
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Information or Instructions
Certification & Signature
Certification:
*
"I certify that this request is made in good faith under the Maryland Public Information Act."
Signature
Submission Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Continue
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