Village of East Rockaway Freedom of Information (FOIL) Request Form

I HEREBY APPLY TO EXAMINE THE FOLLOWING RECORDS(S) PURSUANT TO THE NYS FREEDOM OF INFORMATION ACT (list location of and items to be examined below).

I HEREBY APPLY FOR COPIES OF THE FOLLOWING RECORD(S) PURSUANT TO THE NYS FREEDOM OF INFORMATION ACT (list location of and items to be copied below).

• $30.00 for copies exceeding 11x17 in size

Applicant (Print)   Contact Number / Email

Applicant Signature   Representing (Print)

For Agency Use

Approved   Signature   Date

Denied

NOTICE: You have the right to appeal a denial to the Head of this agency, in writing.

Addressed to:
Mayor Gordon J. Fox
Inc. Village of East Rockaway
376 Atlantic Ave., PO Box 189
East Rockaway, New York 11518-0189