File an Appeal

Requester

Name:

Company:

Address:

Contact:

Agency:

Agency Address:

Agency Contact:

Records at Issue in this Appeal:

(If you run out of space, you may attach a file with more details.)

Request Submitted to Agency Via:

Dates:

Check if no response

Agency Open Records Officer:

I requested the listed records from the Agency named above. By submitting this form, I am appealing the Agency's denial, partial denial, or deemed denial because the requested records are public records in the possession, custody or control of the Agency; the records do not qualify for any exemptions under § 708 of the RTKL, are not protected by a privilege, and are not exempt under any Federal or State law or regulation; and the request was sufficiently specific.

Attach Files:

Maximum file attachments: 10
Maximum file size: 25MB per attachment
Allowed file types: pdf, doc, docx, rtf, txt, xls, xlsx, ppt, pptx, jpg, png, gif, bmp, tiff
Allowed Characters: a-z A-Z 0-9 ( ) . , & _ -

I have attached a copy of my request for records.

I have attached a copy of all responses from the Agency regarding my request.

I have attached any letters or notices extending the Agency's time to respond to my request.

I hereby agree to permit the OOR additional time to issue a final determination:

I am interested in resolving this issue through OOR mediation. (This stays the initial OOR deadline for the issuance of a final determination by 7 business days. If mediation is unsuccessful, the OOR has 30 days from the conclusion of the mediation process to issue a final determination.)

PUBLIC RECORD NOTICE

All filings with the OOR will be public records and subject to public access with limited exception. If you do not want to include personal contact information in a publicly accessible record, please provide alternate contact information in order to receive future correspondence related to this appeal.

Do not include private information such as Social Security Numbers.

Printable versions of this form (revised September 2019):

You will receive a copy of your submission by email.