Application For Public Access To Records Form printable pdf download

APPLICATION FOR PUBLIC ACCESS TO RECORDS

Aaron M. Martin, Records Access Officer

TO:

Edwin L. Crawford County Office Building, Government Plaza

P.O. Box 1766, Binghamton, NY 13902

Telephone: (607) 778-2287

FAX: (607) 778-8869

Email:

FOIL@co.broome.ny.us

Website:

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 ___________________________________________________________________

Email (Optional)___________________________________________________________________

Signature_____________________________________________ Date: ______________________

Please circle your preferred method of contact:

Phone

Mailing Address

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

____Approved

________Number of Copies Responsive to the Request

Denied for Reason(s) checked below:

____Confidential Disclosure

____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) ________________________

_________________________________________________________________________________________

Signature

Title

Date

APPEALS PROCESS

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: _______________________

ADDRESS: _______________________________________________________________________

Application For Public Access To Records Form

Related Articles

Related forms

Related Categories