Name of person or organization that made public records request (last, first, middle initial or organization name)
MM slash DD slash YYYY
Please describe how access to public records was denied in violation of R.C. 149.43(B) (see Attach additional sheets if necessary. Give the date of each request, and be specific as to what records have not been provided.
Attach a copy of original public records request, and copies of any and all written responses or other communications relating to the request from the public office. If the request and/or denial was verbal, provide a detailed description below of the verbal communication with the public office. Attach additional sheets if necessary.