Michael C. Painter
                                                               Chief of Police

                                        Right To Know Request Form

DATE RECEIVED BY POLICE ________________________

DATE REQUESTED: ________________________________

REQUEST SUBMITTED BY:             E-MAIL              U.S. MAIL   FAX    IN-PERSON 

NAME OF REQUESTOR :________________________________________________

STREET ADDRESS :____________________________________________________

CITY/STATE/ZIPCODE/COUNTY : ________________________________________

TELEPHONE (Optional):___________________________________________________

E-MAIL (Optional): _______________________________________________________

RECORDS REQUESTED:

*Provide as much specific detail as possible so the agency can identify the information.

_______________________________________________________________________-

________________________________________________________________________________________________________________________________________________

DO YOU WANT COPIES?                                                     YES or NO

DO YOU WANT TO INSPECT THE RECORDS?                YES or NO

DO YOU WANT CERTIFIED COPIES OF RECORDS?      YES or NO

RIGHT TO KNOW OFFICER / POLICE:________________________________

DATE SUBMITTED _______________________________________________