RDCK Freedom of Information Request Form

Freedom of Information and Protection of Privacy Act

Request for Access to Records
Contact Information*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Information Requested*
The Freedom of Information and Protection of Privacy Act can only be used to request copies of recorded information, not to pose questions to be responded to. Please provide as much detail as possible, such as the date or time frame for records if applicable. This will assist us in responding to your request.
Are you requesting access to another person's personal information?*

YesNo
If YES, please attach either a) that person's signed consent for disclosure, or b) proof of authority to act on that person's behalf.

Cancelof
Signature*

Clear
Date*

MonthDayYear
Date
Note: Information will be released upon receipt of payment of applicable fees.

Personal information contained on this form is collected under the Freedom of Information and Protection of Privacy Act and will be used only for the purpose of responding to your request.
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Freedom of Information and Protection of Privacy Act