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2. Name*
3. Email Address
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Fax Number
14. Description*
    Describe the public record(s) as specifically as possible.
16. Delivery Method*
    -- Select One --EmailFaxMailPick upSchedule appointment to inspect record(s).
17. Please check if you would like

    1. The record(s) on digital media
    2. Certified copy of record(s)
19. Check if Applicable

    I am a designated agent for the nonprofit organization making this FOIA request. This request is made directly on behalf of the organization or its clients and is made for a reason wholly consistent with the mission and provisions of those laws under Section 931 of the Mental Health Code, 1974 PA 258, MCL 330.1931. (Must fill out Waiver of Costs)

    1. Designated Agent
21. Check if Applicable

    1. I am submitting an affidavit and requesting that I receive the discount for indigence. (Must fill out Affidavit of Indigency)
23. Signature*
24. Date*
    Date
26. FOIA Procedures & Guidelines
    Freedom of Information Act Procedures and Guidelines (PDF)

    The City of Zeeland FOIA Procedures and Guidelines and its written public summary are available for public view.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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