Application For Public Access To Records Form - City Of Elmira, Ny

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City of Elmira
CLICK AND TYPE
Office of the City Clerk
317 E. Church St.
Complete this form online
Phone: (607) 737-5672
Elmira, NY 14901
and print to your printer
Fax: (607) 737-5783
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Application for Public Access to Records
The Freedom of Information Law (FOIL) allows an individual to request existing public records from the agency responsible for
maintaining those records. The City of Elmira has a designated Records Management Officer that is responsible for accepting
and responding to FOIL requests. To make a request for existing public records, please complete this form and return it to the
City Clerk's Office at City Hall or complete an electronic form at
/
to request records in an
electronic format.
When you submit this form, FOIL allows the City five (5) business days to make the record available, deny access to the record
with reason, or acknowledge receipt of your request and inform you of the timeframe required to respond to your request.
Read the complete FOI Law online at:
To:
Date: _______________________
Records Management Officer
City of Elmira
I hereby apply to inspect the following specific record: __________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Your Name: ___________________________
Signature: ______________________________________
Your Address: ___________________________________________________________________________
Your Email Address: ____________________________________
if provided, the clerk will notify you by email.
For Agency Use Only
Departmental Recommendation
[ ] Police
[ ] Fire
[ ] Inspection Services
[ ] Other: _________________________
We Recommend:
[ ] Approval
[ ] Disapproval
[ ] Record requested cannot be found [ ] Record is not maintained
Comments: _____________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
______________________________
____________________________ ________________________
Signed
Title
Date
For Agency Use Only
Disposition of Request
[ ] Approved
[ ] Denied
____________________________________________________________________________
[ ] Record of which this agency is legal custodian cannot be found
[ ] Record is not maintained by this agency
________________________________________
___________________________
_
Records Management Officer/Designee
Date
YOU HAVE THE RIGHT TO APPEAL A DENIAL OF THIS APPLICATION.
SUBMIT APPEALS IN WRITING TO THE MAYOR OF ELMIRA.
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Elmira City Hall E-Document
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