CITY OF FAIRMONT FOIA REQUEST

BUSINESS NAME REQUESTING FOIA (if applicable)

REQUESTER'S EMAIL

REQUESTER'S PHONE NUMBER

PURPOSE FOR REQUEST (not required)

I hereby request the release of the following information under WVC §29B-1-1. I understand that certain information may be exempt from disclosure under the code. Specifically, those items set out in WVC §29B-1-4.

Exempt information includes:

A. Trade secrets;

B. Information of a private and personal nature, such as tax information, medical records, unpublished telephone numbers, etc;

C. Testing information;

D. Records of law enforcement agencies and their internal memoranda and notations relating to confidential investigative techniques and procedures;

E. Certian information relating to the regulation of financial institutions;

F. Certain documents and information relating to the location of historical, archeological, and other such sites; and

G. Information which is readily available from another source.

The City of Fairmont has five (5) working days to respond to this request.

I understand and agree to pay a photocopying charge or reproduction fee related to this request of $1.25 per page.

Detailed description of requested information:

Requester's Signature

First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.