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2. First Name
3. Last Name
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Fax Number
14. Email Address
16. Prefered Contact
    -- Select One --TelephoneEmail Fax
17. Response Should Be Returned By:
    -- Select One --EmailMail to Address Provided
18. Do You Represent a Business?
    -- Select One --YesNo
20. Name and Address of Business
22. Are You Willing to Pay a Fee for Requested Records?
    -- Select One --YesNo
23. Please Indicate Maximum Fee Amount
25. Freedom of Information Act Requests
    FOIA requests should list specific information or documents that are desired. Please be aware that there may be a fee charged for staff time and for copies that are reproduced. Surry County staff will respond to FOIA requests within five business days following the receipt of the request. Staff will respond in one of the following ways: 1) Staff will provide you with the records that you have requested in their entirety. 2) Staff may withhold all of the records that you have requested, because all of the records are subject to a specific statutory exemption. If all of the records are being withheld, staff will notify you in writing. That writing must identify the volume and subject matter of the records being withheld, and state the specific section of the Code of Virginia that allows us to withhold the records. 3) Staff may provide some of the records that you have requested, but withhold other records. An entire record cannot be withheld if only a portion of it is subject to an exemption. In that instance, staff may redact the portion of the record that may be withheld, and must provide you with the remainder of the record. Staff must provide you with a written response stating the specific section of the Code of Virginia that allows portions of the requested records to be withheld. 4) If it is practically impossible for staff to respond to your request within the five-day period, you will receive a written notification, explaining the conditions that make the response impossible. This will allow staff seven additional working days, for a total of 12 working days to respond to your request.
27. Please list specific information and/or documents you are requesting:
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

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