Office of the Village Clerk
(607) 798-7861
PLEASE PRINT OR TYPE
AGENCY OR DEPARTMENT FROM WHICH RECORD SOUGHT:
__________________________________________________________
Description of Records Sought (be specific):
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_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Dates: ________________________________________________________________________________
File Designation, if known:
_________________________________________________________________
Other descriptive information:
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Data to be sent via: Mail _____ E-mail_____ Picked up at Village Hall_______
Format: paper($.25/pg)______ 3.5” floppy($.80/disk)______ CD($2.00/cd)_______
Certification Desired: Yes _____ No _____
Date of Request: ________________________ Fee:
_________________plus postage________
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Name of Requestor:
____________________________________
Address: ____________________________________________
City/State/Zip:
________________________________________
Telephone:
_____________________
E-mail address:
________________________
Signature of Requestor:
_____________________________________
END of FORM
Complete and bring or mail this form to the Clerk's Office at the above address
Additional suggestions from Albany
You may cut and paste any of the following to your request if you feel it will
help:
(1) Please email the following records if possible [include as much detail
about the record as possible, such as relevant dates, names, descriptions,
etc.]:
(2) Please advise me of the appropriate time during normal business hours
for inspecting the following records prior to obtaining copies (include as much
detail about the records as possible, including relevant dates, names,
descriptions, etc.):
(3) Please inform me of the cost of providing paper copies of the following
records [include as much detail about the records as possible, including
relevant dates, names, descriptions, etc.].
(4) If all the requested records cannot be emailed to me, please inform me
by email of the portions that can be emailed and advise me of the cost for
reproducing the remainder of the records requested ($0.25 per page or actual
cost of reproduction).
(5) If the requested records cannot be emailed to me due to the volume of
records identified in response to my request, please advise me of the actual
cost of copying all records onto a CD or floppy disk.
(6) If my request is too broad or does not reasonably describe the records, please contact me via email so that I may clarify my request, and when appropriate, indicate the manner in which records are filed, retrieved or generated.
If it is necessary to modify my request, I would prefer to be contacted at
the following telephone number: _____________.
If for any reason any portion of my request is denied, please inform me of
the reasons for the denial in writing and provide the name, address and email
address of the person or body to whom an appeal should be directed.