PUBLIC INFORMATION REQUEST FORM

2. 
4. Name
5. Email Address
7. Company
8. Phone Number
9. Cell Phone Number
11. Address
13. City
14. State
15. Zip Code
17. Information Requested
19. Date Information is Needed
    Date Information is Needed
21. Once this form is received and the estimated staff time and number of documents (if necessary) to comply with this request is calculated, you will receive a letter from the Town Clerk explaining what the maximum cost will be of the requested information. After the Town Clerk receives a signed acceptance of this cost from you, the Town Clerk will then proceed to reply to the public information request or deny the request under the Public Information Act. Annotated Code of Maryland Sections. 10-611 – 10-630. For your information, the Town’s regulations “Access to Public Records” is found in the Mount Airy Town Code, which is on the Mount Airy website, under sections 1-19 – 1-24.

23. P. O. Box, Mount Airy, MD 21771
    Telephone: (301) 829-1424 * Fax: (301) 829-1259
    Email: town@mountairymd.gov * Web Page: www.mountairymd.gov

27. Staff person in charge of request
28. Date Staff Contacted Requester with Follow Up
    Date Staff Contacted Requester with Follow Up
30. Approximate Time Needed to Complete Request
31. Fee if Applicable
32. Fee Received (if applicable)

    1. Yes
    2. No
34. Date Request was Completed
    Date Request was Completed
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