APPLICATION FOR PUBLIC ACCESS TO RECORDS
Aaron M. Martin, Records Access Officer
Edwin L. Crawford County Office Building, Government Plaza
P.O. Box 1766, Binghamton, NY 13902
Telephone: (607) 778-2287
FAX: (607) 778-8869
I HEREBY REQUEST TO INSPECT RECORDS AT BROOME COUNTY’S DEPARTMENT/OFFICE OF_____________________:
I would like to (Please check a box):
Review documents by appointment. (Not available for Sheriff’s records)
Have copies made at 25¢ per (regular-sized) page or at the set fee structure for other formats, and agree to pay for these copies.
(Other Set Fees: $2.00 for CD’s or DVD’s, $2.00 for Polaroid photographs (if available), $.28 for digital full color picture (if available) printed on 8 ½”
x 11” paper, $.50 for pictures printed on photographic paper. There is no charge if a request is under 4 pages or if it can be provided by email.)
I would like an estimate of the number of pages involved in the above request prior to any copies being made.
Please describe the record you are requesting. Be specific – especially with dates and time periods:
Name (Please Print): ________________________________________ Phone: ________________
Mailing Address ___________________________________________________________________
Signature_____________________________________________ Date: ______________________
Please circle your preferred method of contact:
If we have reproduced records that you have not paid for, this new request will not be processed until the prior request is settled.
FOR AGENCY USE ONLY
________Number of Copies Responsive to the Request
Denied for Reason(s) checked below:
____Record of Which this Agency is Legal Custodian
____Part of Investigatory Files
Cannot be Found
____Unwarranted Invasion of Personal Privacy
____Record Does not Exist
____Record is not Maintained by this Agency
____Exempted by Statute Other than the FOI Law
____Other (Specify) ________________________
NOTICE TO APPLICANT: You have the right to appeal a denial of this request by application to the Records Access Officer.
A decision will be made by the Appeals Officer, the Broome County Attorney’s Office, 6
Floor Edwin L. Crawford County
Office Building, in writing with a full explanation within 10 business days from receiving the appeal.
I, ______________________________, hereby appeal my Denied FOIL Request dated: _________
SIGNATURE:_________________________________________ Date: _______________________