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 THIRTY CALENDAR DAYS TO MAYOR, CITY OF PLATTSBURGH, 41 CITY HALL PLACE, PLATTSBURGH, NY 12901, WHO MUST FULLY EXPLAIN REASONS FOR SUCH DENIAL IN WRITING WITHIN TEN BUSINESS DAYS FROM RECEIPT OF AN APPEAL.

I HEREBY APPEAL:________________________________________________

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APPLICATION FOR PUBLIC ACCESS TO RECORDS (FOIL)