FOIL Request Form

Application for Public Access to Records

This form is provided only as a convenience. No particular form of request is required by law. Your request must be in writing. Pursuant to applicable provisions of law, access to some or all of the records may be denied.

Record Identification

Identify records and/or reasonably describe documents you are interested in as clearly as possible. I hereby apply to access the following record(s).

Circumstance

I hereby request to inspect the record(s) in person.

I hereby request a copy of the record(s), for which I agree to pay $0.25 per page.

If available in electronic format, I request the record(s) electronically at no charge.

First

Last

Phone Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Notice

The Freedom of Information Law also stipulates that certain information can be denied, however, the County is required to advise you of your rights to appeal such denials. If you choose to appeal a denial of information, you must do so in writing within 30 days of receipt of such denial. The appealing authority is Chautauqua County Executive, 3 North Erie Street, Mayville, New York 14757. Your appeal must state the date of the denial, the information requested, the information denied, and the reason for the denial.

FOIL Request Form

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