Form E-07 - Foil Application (Page 2 of 2) in pdf

Form E-07 - Foil Application Page 2

APPLICATION FOR PUBLIC ACCESS TO RECORDS

PAGE TWO

This page is to be completed by the Department’s Records Access Officer

Date received: ____________________

If approved:

Number of pages requested: __________

Media costs or other actual costs: _________

Billing Date: __________________

Bill Number: ____________

Bill Amount: _________________

Receipt of your request is acknowledged with this form. This form serves as your bill.

Kindly send a check or money order for $_________ for this FOIL request to

_____________________________________.

The Records Access Officer must check A, B or C below:

__ A. Once the funds have been received, this FOIL request will be filled.

__ B.

There will be a delay in supplying the requested record until: ___________

For the following reason:________________________________________________

__ C. If denied, check one or more of the reasons below:

__ Confidential Disclosure

__ Part of Investigatory Files

__ Unwarranted Invasion of Privacy

__ Record of which this Department is Legal Custodian, Cannot be Found

__ Record is not Maintained by the Department

__ Exempted by Statute Other than Freedom of Information Act

__ Other (specify): ____________________________________________________

Signature of Record’s Access Officer __________________ Date ______________________

Notice to Applicant

You have the right to appeal a denial of this application to the FOIL Appeals Hearing

Officer in writing within 30 days of the denial. The FOIL Appeals Hearing Officer must

respond to you in writing within ten business days of receipt of your appeal.

FOIL Appeals Officer

Ulster County Executive’s Office

244 Fair Street, PO Box 1800

Kingston, New York 12402

Tel.: (845) 340-3800

h/NYSFOILform

Form E-07 - Foil Application Page 2