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Freedom of Information Act Request Form

  1. * Hand delivery or regular mail to City Hall, c/o City Attorney, 333 W. Ellsworth Street, Midland, MI 48640
    * Fax to (989) 837-5703
    * Email to: FOIA@midland-mi.org

  2. I would like to receive my response by:*

  3. be as specific as possible, include date, location, names of parties involved and report number, if available. Failure to sufficiently describe the document may result in a denial of your request pursuant to MCL 15.235(5)(5)(b).

  4. I would like to: *

    (only check one box)

  5. I agree and understand that reasonable charges for copy and mailing costs and labor may be incurred.

    Further I:

  6. If this is a request for a motor vehicle accident report which was filed with the Midland Police Department, by signing below this request will act as my statement that I acknowledge under MCL 257.503, I (and any organization I might represent) am prohibited from: a) using the report for any direct solicitation of an individual, vehicle owner, or property owner listed in the report and b) disclosing any personal information contained in the report to a third party for commercial solicitation, of an individual, vehicle owner or property owner listed in the report, until thirty (30) days after the date the report is filed. Violation of this law is a misdemeanor, subject to fines and imprisonment.

  7. Signature Confirmation*

    of my original, handwritten signature when used on this document and creates a legally-binding statement. I further understand that signing this document using my electronic signature will have the same legally-binding effect as signing my signature using pen and paper.

  8. City of Midland FOIA Procedures & Guidelines: http://cityofmidlandmi.gov/DocumentCenter/View/12108

  9. Leave This Blank:

  10. This field is not part of the form submission.