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Columbia Township

Van Buren County, Michigan

Mary Burgett, Township FOIA Coordinator

53053 C.R. 388

PO BOX 323

GRAND JUNCTION, MI 49056

Tel: (269) 434-6227 Fax: (269) 434-6916

FOIA Request for Public Records

Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq.

Request to: ¨ Receive copy ¨ Inspect record ¨ Subscribe to record issued on regular basis

Name Phone
Firm/Organization Fax
Street Email
City State Zip

Delivery Method (upon payment of balance due): ¨ Pick up records in person ¨ Mail to address below

¨ Email to address below

(Please Print or Type)

Describe the public record(s) as specifically as possible:
Requestor’s Signature Date

Consent to Non-Statutory Extension of Township’s Response Time

I have requested a copy of records or a subscription to records or the opportunity to inspect records, pursuant to the Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq. I understand that the township must respond to this request within five (5) business days after receiving it, and that response may include taking a 10-business day extension. However, I hereby agree to extend the township’s response time for this request until ______________________________________________________________________________________.

Requestor’s Signature

 

 

 Date