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Sample Affidavit in Support of Exemption Log
[Agency logo / letterhead]
Attestation in Support of Exemption Log
Name of Requester: [Name of Requester]
Records Requested: [Description of Request]
Appeal Caption: [OOR Caption and Docket Number]
I, [Name of Agency Open Records Officer], hereby declare, pursuant to 18 Pa.C.S. § 4904, that
the following statements are true and correct based upon my personal knowledge, information and
belief:
Exemption Log Information
1. I serve as the Agency Open Records Officer (“AORO”) for the [Name of Agency]
(“Agency”) and am responsible for responding to Right-to-Know requests filed
with the Agency.
2. In my capacity as the AORO, I am familiar with the records of the Agency.
3. Upon receipt of the request, I conducted a thorough examination of files in the
possession, custody and control of the Agency for records responsive to the request,
specifically… [Provide additional details regarding likely locations of responsive
records, likely custodians of responsive records, the search(es) conducted and the
records or types of records that were reviewed. If the search(es) included emails
or other electronically stored records, identify the location(s) searched (e.g.,
individual email accounts, agency servers, any other servers, service providers,
etc.).]
4. Additionally, I have inquired with relevant Agency personnel and, if applicable,
relevant third-party contractors as to whether the requested records exist in their
possession, specifically… [Provide additional details identifying the parties that
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were contacted, indicating whether the parties responded and describing the
content of the response(s). If applicable, provide additional information
explaining why some or all of the records do not exist or why the Agency does
not possess the records.]
5. After conducting a good faith search of the Agency’s files and inquiring with
relevant Agency personnel, I identified all records within the Agency’s possession,
custody or control.
6. Each of the responsive records withheld are described in the preceding exemption
log.
7. I have reviewed each of the records withheld and verify that the descriptions of
record types, dates, number of pages, subject matters, authors, and recipients as
described in the preceding exemption log are true and correct.
[Exemption #1]
[Include additional paragraphs to support each cited exemption]
Date: ___________________ Signature: ___________________
[Name of AORO]
Agency Open Records Officer
[Name of Agency]
