Required fields are marked with asterisks (*)

Access / Correction Request

Freedom of Information

Please note: A $5.00 application fee payable to the Town of Orangeville is required for all requests.

Request for:

Access to General Records

Access to Own Personal Information

Correction to Own Personal Information

Full name of requester:

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

Last name appearing on records:

First name appearing on records:

Middle name(s) appearing on records:

E-mail of requester:

Requester Contact Information

Phone Number:

Street Address (and Unit # if applicable):

Town or City

Postal Code

Description of the Requested Information

Detailed description of requested records, personal information or personal information to be corrected. If you are requesting access to or correction of your personal information, please identify the info bank or record containing personal info, if known

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 that a statement of disagreement be attached to your personal information.

Supporting Documentation:

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Allowed extensions pdf, doc, docx, jpg, jpeg, gif, png, tif

Preferred method of access to records:

Examine Original

Receive Copy

Personal information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request. Questions about this collection should be directed to the Clerk, Town of Orangeville.

I give my consent for the retrieval of the requested information.

Agree

Disagree

Declaration of Truth

I hereby declare that the information above is true, complete and correct and that any documents submitted along with this form are genuine. I further understand that any false statements, or deliberate omissions on this form, or within any document submitted along with this form, may be considered as false pretenses and upon conviction I may be liable to a fine pursuant to the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA).

Date:

Signature:

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Access / Correction Request

Freedom of Information

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Form Builder

Access / Correction Request

Freedom of Information

Stay Connected with Orangeville

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