I. TO BE COMPLETED BY PERSON REQUESTING ACCESS TO OR COPY OF RECORD IN POSSESSION OF THE TOWN OF ________, ________ COUNTY, WISCONSIN
Description of the record(s) to be inspected and/or copied:
Please note: A request “is deemed sufficient if it reasonably describes the requested record or the information requested. However, a request for a record without a reasonable limitation as to subject matter or length of time represented by the records does not constitute a sufficient request.” (
s. 19.35 (1) (h), Wis. stats.) The request may be made orally, but a request must be in writing before an action to enforce the request is commenced under
s. 19.37, Wis. stats.
Is the record or part of the record requested a personnel record of a town employee? Yes _____ No _____
Please note: A request may not be refused “because the person making the request is unwilling to be identified or to state the purpose of the request.” (
s. 19.35 (1) (i), Wis. stats.)
II. TO BE COMPLETED BY CUSTODIAN OR DEPUTY CUSTODIAN OF RECORD.
Municipal department, office, or work unit of any authority receiving request: (Include name of person receiving request)
Was the request acted upon within 10 days of the request? Yes _____ No _____
Action taken on request: ( ) Approved ( ) Approved in part and denied in part ( ) Denied
If the requested record was a personnel record, was the town employee notified of the request?
Yes ____ No ____*
Please note: For a denial, attach a copy of any statement of the reasons denying access to, a copy of, or other information contained in any public record covered by this request. If the request for the record was in writing, the denial determination is subject to review by mandamus under
s. 19.37 (1), Wis. stats., or upon application to the attorney general or a district attorney. (
s. 19.37 (4), Wis. stats.)
Reason for fee:
If a personal record request, the date and name and address of the town employee notified in writing as to the request and response, if any, received from the employee:
Note: See
s. 19.356, Wis. stats.
