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Complaint Form
Date:_______________________________
Official or Agency:
______________________________________________________________
(name and address)
______________________________________________________________
(telephone, fax and e-mail if available)
Information of Complaining Party:
______________________________________________________________
(name and address)
______________________________________________________________
(telephone, fax and e-mail if available)
Denied access to public records (check here):__________
Denied access to a meeting (check here):__________
Please describe denial of access to meeting or public records below (attach additional sheets if necessary):
______________________________________________________________
______________________________________________________________
_______________________________________________________
_______________________________________________________
PLEASE ATTACH COPIES OF ANY WRITTEN DENIAL OR DOCUMENTATION CONCERNING DENIAL
_______________________________ ___________________________
(Signature) (Date – Month, Day, Year)
SEND TO:
Tavonna Harris Askew, Public Access Counselor
1601 City-County Building
200 E. Washington St.
Indianapolis, IN 46204
Phone: (317) 327-4055
Fax: (317) 327-3968
Email: PAC@indygov.org
NOTE: All information provided on this form is disclosable under the Access to Public Records Act
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