Form 7 Request for Review
Province of Nova Scotia
Freedom of Information and Protection of Privacy Act
Subsection 32(1) (Applicant)
TO:  Review Officer
P.O. Box 181 Halifax, NS B3J 2M4
1.	This Request for Review arises out of an Application for Access to a Record or Request for Correction of Personal Information submitted to	(specify public body) on the	day of	, 20	, a copy of
which Application or Request is attached to this Request for Review.
2.	The applicant requests that the review officer review the following decision, act or failure to act of the head of the public body;
Check where applicable

 		(a)	decision dated or made on the	day of	, 20	, a copy of which is attached to this Request for Review;

 		(b)	(specify act or failure to act)  	

 	.
3.	The applicant requests that the review officer recommend that Check where applicable
 		(a)	the head of the public body give access to the record as requested in the Application for Access to a Record;

 		(b)	the head of the public body correct the personal information as requested in the Request for Correction of Personal Information;

 		(b)	(specify other recommendation or recommendations, if any, you consider appropriate)

[Note: lettering as in original.]

Date:  	

Signature of Applicant:
Print Full Name of Applicant: Mailing Address of Applicant:

(Street/Apartment No./R.R. No.)

(Community/County)

Telephone Numbers of Applicant: Fax Number of Applicant:

(Postal Code)

(Residence) / (Business)