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LandUse@TownOtDOVerNY.us <br />A°°¢ Town of Dover Records Access Office <br />126 East Duncan Hill Road, Dover Plains, NY 12522 <br />(845) 832-6111 telephone (845) 832-3188 fax <br />towncler0townafdoverny.us <br />e07 , <br />Application for Public Access to Records (FOIL) Request <br />Date applied: <br />Underthe provision of the New York Freedom of Information Law, Article 6 of the Public Officers Law (FOIL), <br />I request information from the follow Department ❑ Assessor ❑ Building ❑ Planning ❑ Supervisor ❑ Town Clerk <br />❑ Other (please write in)_—_— <br />Tax Grid # (if applicable): <br />Description of Requested Record: __-- <br />Applicant: -- <br />Address: <br />Streel or P.O Box <br />Cily[Fw Stale Zip <br />Phone: <br />Email address: <br />Fax No: <br />Signature: <br />Response to the Applicant <br />❑ Approved <br />Please check one of the following: <br />❑ 1 request to review these documents in person. <br />❑ 1 request printed reproduction for pick-up at the cost of 25¢ <br />per letter or legal size page, 35¢ for an 11 x 17° page or <br />$1.00 per CD. <br />❑ I request documents to be mailed to the address or faxed to the <br />fax number provided on this form (with corresponding fee if <br />necessary). <br />❑ 1 request documents to be e-mailed (to email provided on form). <br />You may review and/or copy this (these) record(s) as follows: <br />Date: Time: Location: <br />Photocopies or a CD will be provided for the following amount(s): <br />Number of photocopies (250 per copy) No. of copies: Fee: $ <br />Number of CD(s): 41.00 per CD) No of CDs: Fee. $ <br />Postal Service or Fax fee: Fee: $ <br />❑ Denied for the reason(s) checked below: <br />_ Exempted by statute other than Freedom of Information Current examination questions or answers <br />Interagency or intra -agency materials Trade secret confident commercial information <br />_ Wood danger the I% or safety of any person Unwarranted invasion of personal privacy <br />_ Would impair contract awards or coil. barg. agreements _ Record is not maintained by this agency <br />Record of agency as legal custodian cannot be found Other <br />Any person denied access to records may appeal the denial with the Torn Board of the Town of Dover within 30 days of the denial. Such appeals <br />should be addressed to the Supervisor of the Town of Dover, Dover Town Hail, 126 East Duncan Hill Road, Dover Plains, NY 12522. <br />Date Completed: <br />Total Fee: $ <br />Staff Initials <br />Please feel free to contact the office for additional information on this project <br />