Application Information

Use this form to:

• Request access to General Records

• Request access to Own Personal Information

• Correction to Own Personal Information

Description of Information Requested
Detailed description of requested records, personal information or personal information to be corrected

Which Municipal department has the information you are requesting, if you know it:

What are the dates of the information you are requesting for, if applicable:

From:

To:

Contact Information

Email:

Title: Mr.Mrs.Ms.Miss

First Name:

Last Name:

Street Address:

City/Town:

Province:

Postal Code:

Phone #:

Alternate #:

Preferred Method of Access to Records

Examine OriginalReceive Copy Information

Before sending your request, ensure you have:

Provided a detailed description of the information or records you are requesting
If requesting personal information include a photocopy of a signed, government-issued identification (i.e.Driver’s Licence or Passport)

If correcting personal information indicate the desired correction and attach supporting documentation

Payment Method of application fee. Payable to: Municipality of St.-Charles
CashChequeMoney Ordere-Transfer([email protected])