Freedom of Information MFIPPA Request Form

Municipal Freedom of Information and Protection of Privacy

Please note that a $5.00 initial application fee is required and a review will take place to ensure the request is understood before your application can be fully processed. Additional fees may be charged under Section 45 of the Municipal Freedom of Information and Protection of Privacy Act.

Request for:

Access to General Records

Access to Own Personal Information

Correction of Own Personal Information

Name of Institution request made to:

If request is for access to, or correction of, own personal information records:

Last name appearing on records:

Same as below

Or:

Details

Last Name:

First Name:

Middle Name:

(Optional)

Mr.

Mrs.

Ms.

Miss

Mailing Address:

City/Town:

Province:

Postal Code:

Telephone Number: (Day)

May we leave a voicemail?

Yes

No

Email:

Would you like us to communicate with you via email? NOTE: email communications are not secure and may be intercepted, viewed, changed, or saved by others.

Yes

No

Provide as much detail as possible to specify which records you require. If possible, provide dates for the records you are requesting. (If you are requesting access to, or correction of, your personal information, please identify the personal information bank or record containing personal information, if known)

Description:

Note: If you are requesting a correction of personal information, please indicate the desired correction and, if appropriate, attach any supporting documentation. You will be notified if the correction is not made and you may require a statement of disagreement be attached to your personal information.

Preferred method of access to records

Examine Original

Receive Copy

Signature:

Clear

Date:

The Town of Fort Erie is collecting your information as an institution under authority of the Municipal Freedom of Information and Protection of Privacy Act R.S.O 1990 c. M 56. The Town of Fort Erie will use this information for the sole purpose of administering, communicating and responding to your request. Questions about this collection should be directed to the Records Management Assistant at the 905-871-1600 ext. 2214 or via mail/in person at: 1 Municipal Centre Drive, Fort Erie, ON L2A 2S6.

Access/Correction Request