Compliments and Complaints Submission – Chagrin Valley Dispatch

Name of person or organization that made public records request (last, first, middle initial or organization name)

First Last

Name

First Last

Date

Phone

Name of public office

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Name of public official who responded to records request (if no response made, state "None")

Complaint

Please describe how access to public records was denied in violation of R.C. 149.43(B) (see codes.ohio.gov/orc/149.43). Attach additional sheets if necessary. Give the date of each request, and be specific as to what records have not been provided.

Required Attachments or Information

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.