Name*

Email Address*

Address*

City*

State*

Zip Code*

REQUEST - This is a request under the Massachusetts Public Records Law (M. G. L. Chapter 66, Section 10). I am requesting that I be provided a copy of the following records [please include a detailed description of the information you are seeking]:*

I, the requester, realize that I may be charged $.05 for black and white copies when electronic records are not available. When the request is for materials that are not susceptible to ordinary means of reproduction, such as photographs, computer tapes, large maps, etc., then the actual cost of reproduction may be assessed to the requester. I realize I may be charged up to $25/hour for staff time needed for searching, compiling, segregating, redacting and reproducing requested records. If there is to be a cost assessed, the Town will provide a good-faith fee estimate and may require the payment in advance of delivering the request. The Public Records Law requires that the Town provide me with a written response within 10 business days. If the Town cannot comply with my request, the Town is statutorily required to provide to me an explanation in writing.
Sincerely,

[electronic signature]*