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2. Department
   -- Select One --AdministrationCounty ClerkHealthwestHuman ResourcesInformation TechnologyProsecutor's OfficePublic DefenderPublic HealthPublic WorksSheriff's OfficeTreasurer's OfficeWastewaterOther

   Select the department you wish to send your FOIA request to:

3. To Mail or Fax your FOIA Request:
   Mail to: FOIA Coordinator, ADMINISTRATION, 990 Terrace Street, 4th Floor, Muskegon, MI 49442 To Fax: (231) 724-6673
5. Company Name (If applicable)
7. First Name
8. Last Name
10. Phone Number
11. Fax Number
13. Email Address
15. Address
17. City
18. State
19. Zip Code
21. Request for:

    1. Copy
    2. Certified Copy
    3. Record Inspection
    4. Subscription to record issued on regular basis
23. Delivery Method:*

    1. Email to address above
    2. Will pick up
    3. Will make own copies
    4. Mail to address above
25. Describe the public record(s) as specifically as possible.*
27. Electronic Consent to Non-Statutory Extension of County's Response Time

    By checking the "I agree" box below, you agree and acknowledge that you 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 the County must respond to this request within five (5) business days after receiving it, and that the response may include taking a 10-business day extension. However, I hereby agree and stipulate to extend the County's response time for this request.

    1. I agree.
29. Electronic Signature
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field