2. 

   CHARTER TOWNSHIP OF LENOX

   FREEDOM OF INFORMATION ACT REQUEST

   63775 Gratiot Ave. Lenox, MI 48050

4. Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq.
6. Request No.:
7. Date Received:
   Date Received:
9. Check if received via:

   1. Email
   2. Fax
   3. Other Electronic Method
10. Date delivered to junk/spam folder:
    Date delivered to junk/spam folder:
11. Date discovered in junk/spam folder:
    Date discovered in junk/spam folder:
13. Name:
14. Phone:
16. Firm/Organization:
17. Fax:
19. Street Address:
20. Email:
22. City:
23. State:
24. Zip Code:
26. Request for:

    1. Copy
    2. Certified Copy

    1. Record Inspection
    2. Subscription to record issued on regular basis
28. Delivery Method:

    1. Will pick up
    2. Will make own copies onsite
    3. Mail to address above

    1. Email to address above
    2. Deliver on digital media provided by the township
30. Note:
    The township is not required to provide records in a digital format or on digital media if the township does not already have the technological capability to do so.
32. Describe the public record(s) as specifically as possible.
34. Consent to Non-Statutory Extension of Township's Response Time
    
    I have requested a copy of records or a subscription to records or the opportunity to inspect records, pursuant to the Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq. I understand that the township must respond to this request within five (5) business days after receiving it, and that response may include taking a 10-business day extension. However, I hereby agree and stipulate to extend the township's response time for this request until:*
    Consent to Non-Statutory Extension of Township's Response Time
    
    I have requested a copy of records or a subscription to records or the opportunity to inspect records, pursuant to the Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq. I understand that the township must respond to this request within five (5) business days after receiving it, and that response may include taking a 10-business day extension. However, I hereby agree and stipulate to extend the township's response time for this request until:
36. Requestor's Signature*
    (Electronic Signature Accepted)
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field