Town of Remsen FOIL Request Form

To: Records Access Officer

Under the provisions of the New York Freedom of Information Law, Article 6 of the Public Officers Law, I hereby request a copy of records or portions thereof pertaining to (or containing the following):

FOIL Form

Records Requested (required)

If for any reason any portion of the request is denied, you will be informed of the reasons for the denial in writing. Requests will be filled in the order they are received. Requests may take up to 3 days to complete.

First Name (required)

Last Name (required)

Address

City

State

Zip Code

Phone Number (required)

Email (required)

How would you like to receive the records?

I would like to obtain my records: (you must select an option)

By Email (no charge)

In Person ($.25 per page)

Acknowledge (required)

I understand that there is a fee of $.25 per page for duplication of the records requested. If the fee exceeds (please fill in fee amount) please contact me before duplicating records.

Please contact me if the fee will exceed the following amount: (required)