Fillable APPLICATION FOR PUBLIC ACCESS TO RECORDS

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APPLICATION FOR PUBLIC ACCESS TO RECORDS

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Chenango County Sheriff’s Office
APPLICATION FOR PUBLIC ACCESS TO RECORDS
Date: _____________________
To: Records Access Officer
Chenango County Sheriff’s Office
279 County Road 46
Norwich, NY 13815
I HEREBY APPLY TO INSPECT AND/OR OBTAIN COPIES OF THE FOLLOWING RECORD(S):
CASE #, DATE, TIME & PARTIES (include dates of birth) INVOLVED IN INCIDENT
TYPE OF INCIDENT: _____________________________________________________________________
SPECIFIC INFORMATION REQUESTED: ______________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
FOR THE FOLLOWING REASON (Optional):___________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
THE RECORD(S) (CHECK ONE) _______ DO Pertain to me personally.
_______ DO NOT pertain to me personally.
NAME: ______________________________________________________
REPRESENTING: _______________________________________________
MAILING ADDRESS: ____________________________________________
PHONE NUMBER: ___________________________ CELL # _____________________________
FAX NUMBER: ______________________________ E-Mail: _____________________________
SUBMISSION OF APPLICATION:
Submit Electronically
Deliver or Mail To:
Chenango County Sheriff’s Office - Records Access Officer
279 County Road 46
Norwich, NY 13815
Fax: 607-334-2322
Email: jgould@co.chenango.ny.us
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APPLICATION FOR PUBLIC ACCESS TO RECORDS

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Completed 7 July 2022

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