Application for access to a Council Document	SF011
Responsible Officer: FOI Accredited Officer
Issue Date: 30/06/2016
Next Review Date: June 2018

Section 13 FREEDOM OF INFORMATION ACT 1991

Section 132 LOCAL GOVERNMENT ACT 1999

DETAILS OF APPLICANT

SURNAME
GIVEN NAME
AUSTRALIAN POSTAL ADDRESS
POST CODE	TELEPHONE CONTACT NUMBER	DATE

DETAILS OF REQUEST

I REQUEST ACCESS TO DOCUMENT(S) CONCERNING

These documents do / do not contain information about my personal affairs.
(Please cross out whichever does not apply)

NAME OF AGENCY/COUNCIL HOLDING DOCUMENT

FORM OF ACCESS (place tick in appropriate box)

I wish to inspect the documents	( ) Yes	( ) No

I require a copy of the documents	( ) Yes	( ) No

I require access in another form	( ) Yes	( ) No

Specify

Signature of Applicant:

Pursuant to Freedom of Information (Fees and Charges) Regulations 1991 an application fee of $33.50 (includes first 2 hours dealing with the application) must accompany this form – forward the completed form with receipt attached to Jackie Reddaway FOI Accredited Officer.

Additional time for dealing with an application will be charged at $12.50 per 15 minutes, additional charges apply for photocopying, printing and postage.

NB: Prior to completion of this form please contact the Council’s Accredited FOI Officer Jackie Reddaway on 8832 0000 to discuss your request – the information you seek may already be publicly available and can be provided to you without the FOI process.