APPLICATION FOR PUBLIC ACCESS TO RECORDS (FOIL)

NAME OF AGENCY (OR INDIVIDUAL):

(If individual First, MI, Last)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

I HEREBY APPLY TO INSPECT THE FOLLOWING RECORD(S):

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

Signature

Sign above

Mailing Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

FOR AGENCY USE ONLY APPROVED:______

DENIED FOR THE REASON(S) CHECKED BELOW:

◻ CONFIDENTIAL DISCLOSURE	◻ RECORD IS NOT MAINTAINED BY THIS AGENCY
◻ PART OF INVESTIGATORY FILES	◻ EXEMPTED BY STATUTE OTHER THAN THE FREEDOM OF INFORMATION ACT
◻ UNWARRANTED INVASION OF PERSONAL PRIVACY	◻ OTHER (SPECIFY_____________________________________________
◻ RECORD OF WHICH THIS AGENCY IS LEGAL CUSTODIAN CANNOT BE FOUND

SIGNATURE:_______________________________

TITLE:________________________

DATE:____________________

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.

I HEREBY APPEAL:________________________________________________

Sign and Date

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APPLICATION FOR PUBLIC ACCESS TO RECORDS (FOIL)