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2. Date of Request*
   Date of Request
6. Name & Contact Information of Requestor
8. First Name*
9. Last Name*
11. Company (if applicable)
13. Mailing Address 1*
15. Mailing Address 2
17. City*
18. State*
19. Zip*
21. Phone Number*
22. Fax Number
24. Email Address*
28. Records Requested*

    Be clear and concise. Provide as much specific detail as possible, ideally including subject matter, time frame, and type of record or party names. RTKL requests should seek records, not ask questions. Requesters are not required to explain why the records are sought or the intended use of the records unless otherwise required by law.

    You may attach additional pages if necessary. 

30. Attachment
31. Report or File Number (if known)
33. Department*

    1. Police
    2. Public Works
    3. Community Development

    1. Administration
    2. Finance

    1. Recreation
    2. Other
35. Do you want copies?*
    -- Select One --Yes, printed copies (default)Yes, electronic copies preferred if available (sent to the email address provided) No, in-person inspection of records preferred (may request copies later)
36. Do you want certified copies?*
    -- Select One --Yes (may be subject to additional costs)No
38. Fees

    Requests may require payment or prepayment of fees. See the Township of North Fayette Right-to-Know Policy and Fee Schedule for more details.

39. Do you wish to be notified if there is a fee associated with this request?*
    -- Select One --YesNo
41. I certify that I am a legal resident of the United States.*
    -- Select One --YesNo
43. Signature of person making the request*

    The Office of Open Records (“OOR”) will respond to this request within five (5) business days.

    You will be notified if, pursuant to Section 902(a) of the Right to Know Law, the OOR requires an additional 30 days to respond.

45. Do you agree?*

    By clicking "I agree", you agree and acknowledge that: 

    1) your application will not be "Signed" in the sense of a traditional paper document; and 

    2) By signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I Agree
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field