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Application for Records, Article 6 - - Public Officers Law, Freedom of Information Act
Complete Part 1 of this form. Explain in detail the nature and extent of the record(s) being
requested. Advance payment (see below) is required in check or money order payable to the
Town of LeRay before documents will be released.
Send the completed application to the Records Access Office, Town of LeRay, 8650
LeRay
Street, Evens Mills, New York 13637-3191
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Date:______________________________________________________________
Reference__________________________________________________________ |
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Under the
provisions of the New York State Article 6 -- Public Officers Law Freedom of
Information Act, I hereby apply to inspect , or receive copies of the
following records
( use additional sheets as needed and attach)
______________________________
__________________________________________________________________ |
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Name:______________________ Phone (____)_________E-Mail______________
Firm:______________________________________________________________
Address:___________________________________________________________
Signature:_____________________________ Date:_______________________
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| 2. Disposition of Request
❑ Approved - - - - - - -To arrange for access to the records, please contact:
Town Representative_______________ Date:__________ Phone#:_____________
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❑Denied - - for reason (s) checked: References are Sec. 87 of the Public Officers Law.
❑Exempt: State/Fed. Statute (2(a)) ❑ Exempt: Law enforcement (2(e))
❑Invasion of personal privacy (2(b)) ❑ Inter/Intra-agency material (2(g))
❑Competitive position injury (2(d)) ❑ Other____________________
Material Redacted___________________________________________________
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You may appeal a denial within 30 days by writing the the Town of LeRay
Supervisor,
8650 LeRay Street, Evans Mills, New York 13637-3191 |
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❑Unavailable - - for reason checked
❑Not described in sufficient detail ❑ Not maintained by the Town
Other:____________________________________________________________
Signed:_________________________________
Date:_____________________
Title:___________________________________
Phone:(____)_______________
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