Standard Right-to-Know Law Request Form Good communication is vital in the RTKL process. Complete this form thoroughly and retain a copy; it may be required if an appeal is filed. You have 15 business days to appeal after a request is denied or deemed denied. Submitted to Agency Name Date of RequestMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Submitted Via Email U.S. Mail Fax In Person Name Company (if applicable) Mailing Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email TelephoneFax How do you prefer to be contacted if the agency has questions? Telephone Email U.S. Mail Records RequestedBe clear and concise. Provide as much specific detail as possible, ideally including subject matter, time frame, and type of record or party names. RTKL requests should seek records, not ask questions. Requesters are not required to explain why the records are sought or the intended use of the records unless otherwise required by law. Use additional pages if necessary.Do You Want Copies? Yes, printed copies (default if none are checked) Yes, electronic copies preferred if avaliable No, in-person inspection of records preferred (may request copies later) Do you want certified copies?RTKL requests may require payment or prepayment of fees. See the Official RTKL Fee Schedule for more details. Yes (may be subjected to additional costs) No Please notify me if fees associated with this request will be more than $100 Other amount Specify Amount Appropriate third parties notified and given opportunity to object to the release of requested records. NOTE: In most cases, a completed RTKL request form is a public record. More information about the RTKL is available at https:l/www.openrecords.pa.qov
