J. Robert Jamerson Memorial Library
Freedom of Information and Records
10.4 Approval of Request for Public Records
Patron____________________________________________ Date________________
Address____________________________________________
Phone Number________________________________________
Description of Requested Record(s)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Your request dated ________________ for the above records has been approved.
________ The documents you requested are enclosed.
________ The documents will be made available upon payment of copying and postage costs in the amount of ________________.
________ You may inspect the records at ________________________________________ on ________________ (date).
Signed________________________________________________________ Date________________
Freedom of Information Officer
Submit request to:
J. Robert Jamerson Memorial Library
157 Main Street, P.O. Box 789
Appomattox, Virginia 24522
Telephone: (434) 352-5340
Fax: (434) 352-0933
For office Use Only
________ Amount Deposited
________ Amount Due