FREEDOM OF INFORMATION LAW REQUEST Date:_______________ TO: RECORDS OFFICER, Village of Naples, PO Box 386, Naples, NY 14512 I, __________________________ , __________________________________________ NAME, PRINT OR TYPE

MAILING ADDRESS

___________________________ , do hereby apply ( TO INSPECT) (FOR A COPY OF) REPRESENTING

the following record (s) at a cost of $ .30 per photocopy up to 9 by 14 inches. Fees for the other records will be charged based upon the actual cost of reproduction. PLEASE EXPLAIN YOUR REQUEST FULLY. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Telephone contact #: Cell: Fax: SIGNED: *

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FOR AGENCY USE ONLY APPROVED_________

DENIED________ (reasons checked below)

____Confidential disclosure ____ Part of Investigatory Files ____Unwarrented Invasion of Personal Privacy ____Record which this agency has legal custody, but cannot be found ____Record is not maintained by this agency ____Exempted by Statute other than the Freedom of Information Act ____Other (specify) _________________________________________________ _________________________________________________________________ _________________________________________________________________ _______________________________

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Signature, Records Access Officer

Date Available

YOU HAVE A RIGHT TO APPEAL A DENIAL OF THIS APPLICATION TO THE HEAD OF THIS AGENCY, MAYOR OF THE VILLAGE OF NAPLES, 106 SOUTH MAIN ST, NAPLES, NY 14512, WHO MUST FULLY EXPLAIN THE REASON FOR SUCH DENIAL IN WRITING WITHIN TEN DAYS OF RECEIPT OF APPEAL. I HEREBY APPEAL______________________________________

DATE__________