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2. 
3. Freedom of Information Request Form (FOIA)

   City Clerk Jennifer A. Zelmanski

   (586) 445-5443

5. Personal Information
7. Name*
9. Firm/Organization Name*
11. Street Address*
13. City*
14. State*
15. Zip Code*
17. Contact Email Address*
19. Contact Phone Number*
21. Fax Number
23. Request for:*

    1. Copy of Public Records
    2. View Public Records
24. Delivery Method*

    1. Hold for Pickup
    2. US Mail
    3. Overnight
    4. Email
    5. Fax
    6. Not Applicable

    Delivery options may vary based on request.

26. Records Requested*

    Please describe the public record(s) as specifically as possible.

28. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    I further attest that all of the statements made herein are true and correct.

    1. I agree.
30. Electronic Signature*
32. Date*
34. Non-Electronic Submittal Instructions

    If you choose to print this application, please mail or hand deliver it to the City Clerk's Office- City of Roseville- 29777 Gratiot Avenue, Roseville, MI  48066.

    License will be issued by the City Clerk if approved.

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field