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Sample Request Form for Massachusetts
(Address of institution who possesses the records you are requesting)
Dear Dr. ____,
This request for records is made under chapter 66, section 10 of the statutes of Massachusetts. I am _______(list the name of the organization you are with, and your organizational title ) organization. ______ (name of the organization) is a (list your organizational status re: non-profit/tax-exempt) organization dedicated to educating the public about issues concerning animal rights.
The documents requested from the _____ (facility name) are:
The requester is prepared to pay for all actual search and reasonable duplication fees up to an initial amount of twenty-five dollars ($25.00). If the fees will exceed this amount provide me with a detailed estimation of the fee, in advance before performing said work.
The requester asserts that all records requested above are entitled to be given to him as they are public records as defined in Clause twenty-sixth of section seven of chapter four of the Statutes of Massachusetts. Should you make an opposite decision, please segregate all claimed exempt portions, provide me with a specific detailed statement of your position with specific reference to the exemptions listed in clause twenty-sixth of section seven of chapter four, of the statutes of Massachusetts
The Requester, further, requests a response to this request within ten (10) days of its receipt as required by chapter 66, section 10, paragraph (b), of the Statutes of Massachusetts.
(your name and organizational title)
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