Freedom of Information Request Form

This form can be used to submit a Freedom of Information Request.

Separate requests are required for different subject matters. Please use the File Search Application process when seeking building and septic permit information (installation reports, occupancy permits, copies of drawings, inspection reports, etc.).

A $5.00 application fee is required for all requests. Requests are not considered complete until payment is received. Please contact the Deputy Treasurer to arrange for payment.

If you have any questions regarding this form, please contact the Municipal Clerk at 705-457-1740 ext. 631 or email mbishop@dysartetal.ca.

Notice of Collection: Personal information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, Ch. M.56, and will be used solely for the purpose of responding to your request.

Last Name

First Name:

Middle Initial:

Address: (Street/Apt. No./P.O. Box/R.R. No.)

City/Town

Postal/Zip Code:

Telephone Number:

Email Address:

Please select the type of information being requested:

Access to general records

Access to your own personal information

Access to other's personal information by authorized party (Proof of authorization must be provided)

Correction of your own personal information

Provide a detailed description of the requested records, personal information or personal information to be corrected. If the space provided is not sufficient additional pages can be attached.

Upload additional information here. File size can be no more than 2MB and must be in doc, docx, txt or pdf format.

Browse…

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Is your request for a specific date or a date range? (Please specify dates)

Have you contacted another department with this request?

Yes

Preferred method of access to records:

Receive Copy

Examine Original

Signature:

Clear

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Freedom of Information Request Form