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APPLICATION FOR PUBLIC ACCESS TO RECORDS (FOIL)

  1. APPLICATION FOR PUBLIC ACCESS TO RECORDS

  2. (If individual First, MI, Last)

  3. Street Number, Street Name, City, State, Zip Code

  4. Please be as specific as possible, including time periods, names, etc. to help ensure proper record retrieval.

  5. Signature

  6. Street #, Street Name, (or P.O. Box #), City, State, Zip Code

  7. (Area Code) XXX-XXXX

  8. FOR AGENCY US ONLY APPROVED:______

  9. DENIED FOR THE REASON(S) CHECKED BELOW:

  10. MM-DD-YYYY

  11. NOTICE: YOU HAVE THE RIGHT TO APPEAL A DENIAL OF THIS APPLICATION WITHIN SEVEN BUSINESS DAYS TO MAYOR & CITY CLERK, 41 CITY HALL PLACE, PLATTSBURGH, NY 12901, WHO MUST FULLY EXPLAIN REASONS FOR SUCH DENIAL IN WRITING WITHIN TEN DAYS FROM RECEIPT OF AN APPEAL.

  12. I HEREBY APPEAL:________________________________________________

    Sign and Date

  13. Leave This Blank: