2. Name
3. Email Address
5. Company
6. Phone Number
7. Cell Phone Number
9. Address
11. City
12. State
13. Zip Code
15. Information Requested
17. Date Information is Needed
    Date Information is Needed
19. 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.

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

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

    1. Yes
    2. No
32. Date Request was Completed
    Date Request was Completed
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field