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2. Please read before continuing

   If you are seeking information related to public safety or criminal justice, please use the form at this link.

4. First Name
5. Last Name
7. Firm/Organization
8. Email Address
10. Phone Number
11. Fax Number
13. Address
15. City
16. State
17. Zip Code
19. Request for

    1. Copy
    2. Certified Copy
    3. Record Inspection
    4. Subscription to record on regular basis
20. Delivery Method

    1. Will pick up
    2. Will make own copies on site
    3. Mail to address above
    4. Email to address above
    5. Deliver on digital media provided by the county
22. Describe the public record(s) as specifically as possible.
24. Records Located on Website

    If Cass County directly or indirectly administers or maintains an official internet presence, any public records available to the general public on that internet site at the time the request is made are exempt from any labor charges to redact (separate exempt information from non-exempt information). 

    If the FOIA coordinator knows or has reason to know that all or a portion of the requested information is available on its website, the county must notify the requestor in its written response that all or a portion of the requested information is available on its website. The written response, to the degree practicable in the specific instance, must include a specific webpage address where the requested information is available. On the detailed cost itemization form, the county must separate the requested public records that are available on its website from those that are not available on the website and must inform the requestor of the additional charge to receive copies of the public records that are available on its website.

    If the County has included the website address for a record in its written response to the requestor and the requestor thereafter stipulates that the public record to be provided to him or her in a paper format or other form, including digital media, the county must provide the public records in the specified format (if the county has the technological capability) but may use a fringe benefit multiplier greater than the 50%, not to exceed the costs of providing the information in the specified format.

26. Request for Copies/Duplication of Records on County Website

    I hereby stipulate that, even if some or all of the records are located on a county website, I am requesting that the county make copies of those records on the website and deliver them to me in the format I have requested above. I understand that some FOIA fees may apply

28. Electronic Signature
29. Date
    Date
33. Overtime Labor Costs

    Overtime wages shall not be included in the calculation of labor costs unless overtime is specifically stipulated by the requestor and clearly noted on the detailed cost itemization form.

35. Consent to Overtime Labor Costs

    1. Labor to copy/duplicate
    2. Labor to locate
    3. Labor to redact
    4. Contract Labor to redact
    5. Labor to copy/duplicate records already on the county's website

    I hereby agree and stipulate to the county using overtime wages in calculating the following labor costs as itemized in the following categories:

37. Electronic Signature
38. Date
    Date
42. Request for Discount: Indigence

    A public record search must be made and a copy of a public record must be furnished without charge for the first $20 of the fee for each request by an individual who is entitled to information under this act who:

    1. Submits an affidavit stating that the individual is indigent and receiving specific public assistance, OR
    2. If not receiving public assistance, stating facts showing inability to pay the cost because of indigence.

    If a requestor is ineligible for the discount, the public body shall inform the requestor specifically of the reason for ineligibility in the public body's written response. An individual is ineligible for this fee reduction if ANY of the following apply:

    1. The individual has previously received discounted copies of public records from the same public body twice during that calendar year.
    2. The individual requests the information in conjunction with outside parties who are offering or providing payment or other remuneration to the individual to make the request. A public body may require a statement by the requestor in the affidavit that the request is not being made in conjunction with outside parties in exchange for payment or other remuneration. 

    I am submitting an affidavit and requesting that I receive the discount for indigence for this FOIA request. (Leave blank if this does not apply)

44. Electronic Signature
45. Date
    Date
49. Request for Discount: Nonprofit Organization

    A public record search must be made and a copy of a public record must be furnished without charge for the first $20 of the fee ofr each request by a nonprofit organization formally designated by the state to carry out activities under subtitle C of the Development Disabilities Assistance and Bill of Rights Act of 2000 and the Protection and Advocacy for Individuals with Mental Illness Act, if the request meets ALL of the following requirements: 

    1. Is made directly on behalf of the organization or its clients.
    2. 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
    3. Is accompanied by documentation of its designation by the state, if requested by the county.

    I stipulate that I am a designated agent for the nonprofit organization making this FOIA request and that this request is made directly on behalf of the organization and its clients and is made for a reason wholly consistent with the mission and provisions under those laws under section 931 of the Mental Health Code, 1974 PA 248, MCL 330.1931.

51. Electronic Signature
52. Date
    Date
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field