Date of request: __________________________
Requestor
name if given: _______________________
How
to contact them: ____________
________________________________________________________________________________
Reason for request if they volunteer the information:
________________________________________________________________________________
Information requested:
Dates of information requested:
What choice of media do they
want the data:
Paper
copies are 25 cents per page plus postage
Email is free
Cost for CD ($1) plus postage
Date employee called for
follow-up if needed:
Date
of request completion: __________
Requestor’s choice as to mode of delivery: mail pickup email
List of any data that was redacted due to privacy laws:________________________
Submit request: Drop
off - 2700 Columbus Avenue, Sandusky, Oh
Fax - 419-625-9622
Email - [email protected]
Telephone request will not be accepted.