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2. County:

   Keep original and provide copy of both sides, along with Public Summary, to requester at no charge.

3. Request Form
   Note: Requesters are not required to use this form. The county may complete one for record keeping if not used.
5. Lenawee County Sheriff's Office
   405 N Winter Street
   Adrian, MI 49221
   
   Phone:517-263-0524
   Fax: 517-265-2284
   Email
   Website
7. FOIA Request for Public Records
   Michigan Freedom of Information Act, Public Act 442 of 1976, MCL 15.231, et seq.
9. Request Number
10. Date Received
    Date Received
12. Check if received via:

    1. Email
    2. Fax
    3. Other Electronic method
13. Date Delivered to junk/spam folder
    Date Delivered to junk/spam folder
14. Date discovered in junk/spam folder
    Date discovered in junk/spam folder
16. Name
18. Firm of Organization
20. Phone
21. Fax
22. Email
24. Address
26. City
27. State
28. Zip Code
30. Request For:

    1. Copy
    2. Certified copy

    1. Record Inspection
    2. Subscription to Record Issued on Regular Basis
32. Delivery Method

    1. Will Pick Up
    2. Will Make Own Copies Onsite
    3. Mail to Address Above

    1. Email to address Above
    2. Deliver on Digital Media Provided by the County
34. Which County
36. Note: This county is not required to provide records in a digital format or on digital media if the county does not already have the technological capability to do so.
38. Describe the public record(s) as specfically as possible. You may use this form or attach additional sheets.
40. Attach additional sheets if necessary
42. Consent to Non-Statutory Extension of County'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 county must respond to this request withing 5 business days after receiving it, and that response may include taking a 10 business day extension. However, I hereby agree and stipulate to extend the county's response time for the request until the following date:
44. Date of Response
    Date of Response
46. Requester's Signature
47. Today's Date
    Today's Date
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

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