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2. FOIA Fee Waiver

   Please provide details below for consideration regarding a waiver of FOIA fees. 

4. Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Cell Number*
16. When did you make your FOIA request?*
17. What was the topic of your FOIA request?*
19. To which office did you send your request? *
21. Explain in detail why the fee should be waived for processing these FOIA records.*
23. Does the submittal of these records add clarity and understanding to a topic of public interest/public issue?*

    1. Yes
    2. No
    3. Unsure
25. Explain any financial hardship toward paying FOIA fees for this request.
26. Please attach files/reports that indicate a financial burden in fulfilling this FOIA request. *
28. I have read and understand Campbell County's FOIA fee policy.*

    1. Yes
    2. No

    Visit http://www.campbellcountyva.gov/558/Transparency-and-the-Freedom-of-Informat to read Campbell County's FOIA information and fee policy. 

30. 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.

    1. I agree.
32. Electronic Signature
34. Thank you for your submission. Staff will review your waiver request and be in touch as soon as possible.
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field