Public Records Request Form

Name * Required
First Last
Email * Required
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone * Required
This is a request under the Massachusetts Public Records Law (M.G.L. Chapter 66, Section 10). I am requesting that I be provided a copy of the following records: * Required
After the requested records are retrieved I would like to: * Required
- Inspect the records
- Receive a hard copy via Mail
- Pick up a hard copy in person
- Receive electronic copies via email provided
The Public Records Law requires you to provide me with a copy of or allow me to inspect the records requested above within 10 business days. If you cannot fully comply with my request, you are statutorily required to cite an exemption and to explain how and why the exemption applies to the records I am seeking. I understand that any reasonable fees associated with my request must be paid prior to my receiving or inspecting said records. By writing your name and date below you are giving your signature to the above statement. * Required
Name
Date * Required
MM slash DD slash YYYY

Date