Request for Access to a Governmental Record




PLEASE COMPLETE THE FOLLOWING:


I____________________________________________________, hereby request access under
                Print full name

NH RSA 91-A to the following governmental record.


Record Date:_______________      Records Name:_____________________________________



Signature_________________________________________ Request Date:__________________


Mailing address:_________________________________________________________________

                _________________________________________________________________

Email address:   _________________________________________________________________

Telephone  #     _________________________________________________________________



                                        
IN ACCORDANCE WITH RSA 91-A, THE TOWN WILL DETERMINE WHETHER THE REQUESTED GOVERNMENTAL RECORD IS AVAILABLE FOR PUBLIC INSPECTION.  UPON SUCH DETERMINATION IT SHALL, WITHIN 5 BUSINESS DAYS OF THE DATE OF REQUEST, MAKE THE RECORD AVAILABLE, DENY THE REQUEST IN WRITING WITH SPECIFIC REASONS, OR ACKNOWLEDGE THE RECEIPT THE REQUEST WITH STATEMENT OF THE TIME REASONABLY NECESSARY TO DETERMINE WHETHER THE REQUEST WILL BE GRANTED OR DENIED.