Freedom of Information Act
Expense and Receipt Form
Requestor:_______________________________________
The following charges have been incurred in responding to your Freedom of Information Act request dated:________________.
$_____________Labor costs (accessing, duplicating, supplying, searching or redacting
record):____________hours @ hourly salary rate.
$_____________Copying costs:____________pages @ current copy center rate.
$_____________Computer time costs as charged to the University.
$_____________Media costs.
$_____________Postage.
$_____________TOTAL COSTS.
<$___________>Less advance deposit (if any).
$_____________AMOUNT
DUE
Please make check
payable to “George Mason University.”
By:_____________________________
Department:______________________
Address:_________________________
__________________________
Date:_____________