In this part of the form enter:

• your last name, first name and preferred title, if any;
• your complete mailing address and daytime and evening telephone numbers so that public body can contact you about the request; and
• a fax number or e-mail address, if any, where correspondence may be sent.

1. Whose information do you want to correct? Indicate whether you want your personal information or another person’s information to be corrected.
   1. Your personal information - If you want your information to be corrected, you will have to provide proof of your identity.
   2. Another person’s information - If you want the information of another person to be corrected, you will have to provide proof that you have the authority to act for that person. For example, you might provide proof that you are the person’s guardian or trustee or that you have power of attorney for the person.
2. Enter the name of the public body that you believe has the records that you want corrected.

1. What records contain the information that you want corrected?
   1. Be as specific as possible in describing the records. The more specific your request, the more quickly and accurately it can be answered.
   2. If you need more space, please continue your description on a separate sheet of paper and attach it to this form.
2. If you want a correction made to your own personal information, please be sure that you give:
   1. your full name;
   2. any other names that you have used on the records, and
   3. any identifying number that relates to the records, such as your employee number, case number or other identification number.
3. If you want a correction made to another person’s information, please give the following:
   1. the person’s full name;
   2. any other name that person may have used on the records; and
   3. any identifying numbers for the person if you know them.
4. What correction do you want made? What is incorrect about the information that is currently on the record? Please be specific.