Request for Public Record Δ Name(Required)Email(Required) Address(Required)Phone(Required)Fax NumberCity(Required)State(Required)Zip Code(Required)Firm/OrganizationDescribe the public record(s) as specifically as possible(Required)Delivery Method(Required) Email Fax Mail Pickup Schedule an appointment to inspect documents Please check if you would like The record(s) on digital media Certified copy of record(s) Check if ApplicableI am a designated agent for the nonprofit organization making this FOIA request. This request is made directly on behalf of the organization or its clients and is made for a reason wholly consistent with the mission and provisions of those laws under Section 931 of the Mental Health Code, 1974 PA 258, MCL 330.1931. (Must fill out Waiver of Costs) Designated Agent I am submitting an affidavit and requesting that I receive the discount for indigence. (Must fill out Affidavit of Indigency) Date(Required) MM slash DD slash YYYY
