Required fields are marked with asterisks (*)

Request under the Municipal Freedom of Information and Protection of Privacy Act

Please Note: A $5.00 application fee is required for all requests

Type of request

Access to General Records

Access to Own Personal Information

Correction to Own Personal Information

Name of Institution this request is made to

If this request is for access to, or correction of, own personal information, please enter the Last Name appearing on records:

Contact Information

Last name

First name

Middle name

Mailing address

City/Town

Postal code

Telephone

Detailed description of requested records, personal information or personal information to be corrected

Note: If you are requesting a correction of personal information, please indicate the desired correction, and if appropriate, attach any supporting documentation.

Preferred method of access to records

Examine original

Receive copy

Signature

Clear

Date

Personal Information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Questions about this collection should be directed to the Freedom of Information and Privacy Co-ordinator at the institution where the request is made.