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2. Please read carefully. Complete this form and retain a copy; this copy may be required if an appeal is filed. You have 15 business days to appeal after a request is denied or deemed denied. More information about the RTKL is available at https://www.openrecords.pa.gov. In most cases, a completed RTKL request form is a public record.

4. Date of Request:*
   Date of Request:
6. First Name
7. Last Name
9. Company (if applicable)
11. Address1
13. Address2
15. City
16. State
17. Zip
19. Telephone No.
20. I request (check applicable boxes) of the following records:*

    1. Review
    2. Duplication
21. Requested information to be:*

    1. Picked-up
    2. Faxed
    3. Mailed
    4. E-mailed
23. E-mail address
24. Fax No.
26. By checking the below box, I affirm that my full name and contact information is true and correct, and that I am a legal resident of the United States. I understand that failure to check this box may result in the denial of my request and the dismissal of any appeal filed with the Office of Open Records.*

    1. I affirm information is true and correct
28. RECORDS REQUESTED: Provide as much detail as possible, including subject matter, time frame, and type of record sought. RTKL requests must seek records, not ask questions. Use additional pages if necessary.*

30. Records shall be provided in the medium requested if they exist in that medium; otherwise, they shall be provided in the medium in which they exist. See Section 701. Your request may require payment or prepayment of fees. View the Official RTKL Fee Schedule for more details.

32. Fees:*

    I understand that my request may incur fees.  Notify me before further processing if fees will be more than:

    1. $100
34. Do you want certified copies:

    1. Yes (may be subject to additional costs)
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field