RIGHT-TO-KNOW REQUEST FORM

DATE REQUESTED:

REQUEST SUBMITTED BY: E-MAIL U.S.MAIL FAX IN-PERSON

NAME OF REQUESTOR: ______________________________________________

STREET ADDRESS: ______________________________________________

CITY/STATE/COUNTY (Required): ______________________________________

TELEPHONE (Optional): ______________________________________________

RECORDS REQUESTED:

*Provide as much specific detail as possible so the agency can identify the information.

DO YOU WANT COPIES? YES or NO

DO YOU WANT TO INSPECT THE RECORDS: YES or NO

DO YOU WANT CERTIFIED COPIES OF RECORDS? YES or NO

RIGHT TO KNOW OFFICER:

DATE RECEIVED BY THE AGENCY:

AGENCY FIVE (5)-DAY RESPONSE DUE:

Send to: Right-To-Know-Officer

Oakmont Water Authority

P.O. Box 73

Oakmont, PA 15139