TO:

FROM:

Name

OFFICE OF THE COMMISSIONER

Address

Department

Address

Phone Number

DESCRIPTION OF RECORD(S) REQUESTED:

The response to your request dated ______________ for the above captioned records must be delayed.  The delay in responding to your request is for the following reasons:

(Provide reason for delay in accordance with Section 3(d) of the FOIA.)

You will be notified by

as to the action taken on your request.

(date)

OFFICE OF THE COMMISSIONER

Date