FOI Request Form - Town of Espanola

Request Form

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

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

e-Transfer’s are now accepted using [email protected]

Request for *

Access to General Records Access to Own Personal InformationCorrection to Own Personal Information

Name of institution request made to *

If request is for access to, or correction of own personal records:

Last name appearing on records:

Same as below

Last name (different than below)

Salutation *

Mr.Mrs.Ms.Miss

Last Name *

First Name *

Middle Name *

Telephone No. (day) *

Telephone No. (evening) *

Address (Street/Apt/No./PO Box/ R.R/No.) *

City/Town *

Province *

Postal Code *

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. You will be notified if the correction is not made and you may require that a statement of disagreement be attached to your personal information.

Preferred method of access to records *

Examine Original Receive Copy

Signature *

Please enter your full name. This will be used in place of a signature.

Date *

Contact Email(s):

Enter contact emails to receive a copy of your submission (comma separated).

Personal information contained on this form is collection pursuant to the Freedom of Information and Protection of Privacy Act/Municipal Freedom of Information and Protection of Privacy Coordinator at the institution where the request is made.

Captcha *