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2. In accordance with maryland’s public information act, title 4 of the general provisions article of the annotated code of maryland, the undersigned requests a copy of all public records containing information hereinafter described.

4. Please refer to the Maryland Public Information Act Guidelines for information on the timing of a response to your request. A response may include a copy of responsive records or notification that responsive records are available for your review.

   The first 40 pages of black and white, single-sided copies of documents requested are free. A copying fee of $.20 per single sided letter page will be charged for additional copies.

   
   

   Records will be released only upon full payment of required fees. Large requests will require a deposit. A waiver of fees may be requested. Waiver determinations are made on a case-by-case basis.

   
   

   Questions should be directed to MPIA Coordinator.

   
   

   Contact

   The City of Rockville
   111 Maryland Ave.
   Rockville, MD 20850

   Email: mpia@rockvillemd.gov
   Phone: 240-314-8139
   Fax: 240-314 -8130

6. Date
   Date
8. First Name*
9. Last Name*
11. Address 1
13. City
14. State
15. Zip
17. Phone
18. Email*
20. List the requested public records*
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22. 1. Receive an email copy of this form.
23. Email address

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24. Submit

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