Access or Correction Request Form

Required fields are marked with asterisks (*)

Municipal Freedom of Information and Protection of Privacy Act

Name of Institution request made to: Corporation of Town of Prescott

Submit to:

Municipal Clerk
Prescott Town Hall
360 Dibble Street West
P.O. Box 160
Prescott, ON
K0E 1T0

INCLUDE A $5.00 APPLICATION FEE

Request for:

Correction of Own Personal Information

Access to Own Personal Information

Access to General Records

If request is for access to, or correction of, own personal information records, please indicate the last name appearing on records:

Details:

Last Name

First Name

Address ( Street/Apt. No./P.O. Box No.)

City or Town

Postal Code

Contact Phone Number

E-mail Address

Detailed description of requested records, personal information to be corrected. If you are requesting access to, or correction of, your personal information, please include your date of birth.

Please attach any additional supporting documentation.

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

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.

Preferred method of access to records

Receive an electronic copy

Receive a printed copy

Please sign

Clear

Please enter the date

EACH SEPARATE REQUEST MUST BE ACCOMPANIED BY THE $5.00 APPLICATION FEE. CHEQUES AND MONEY ORDERS SHOULD BE MADE AYABLE TO THE TOWN OF PRESCOTT.
Please note, additional processing fees may apply.

Personal information contained on this form is collected pursuant to the 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 Town Clerk at (613)925-2812.