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2. Michigan Freedom of Information Act

   Request for Public Records

4. Name of Requester
6. Address
8. City
9. State
10. Zip Code
12. Contact Phone Number
13. Contact Email

15. Please state the name of the public record you are requesting and include the following:

17. Names Referred to in Record:
18. Date of Record:
20. Location of Event:
22. Other helpful information to identify the record:
24. Method of Access Desired

    1. Pickup
    2. Email
    3. Mail
    4. Examine
26. Mailing Address (if different than above):
27. City:
28. State & Zip:
30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature
33. Date
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field