APPLICATION FOR PUBLIC ACCESS TO RECORDS
CLINTON COUNTY SHERIFF’S OFFICE
25 McCARTHY DRIVE
PLATTSBURGH, NY 12901
Print Name:________________________ Date of Birth:___________________
Address:___________________________________________________________
Phone #:___________________ Information on: ( ) Myself ( ) Other
Email Response, Please Provide Address:_______________________________
I hereby apply to inspect the following records: (Please Describe In Detail)
Requestor’s Signature:_______________________________________________
AGENCY USE ONLY
APPROVED_____________
DENIED_________________(FOR THE REASONS CHECKED BELOW)
_____Confidential Disclosure _____ Part of Investigatory Files
_____Unwarranted Invasion of Personal Privacy
_____Record of Which This Agency is Legal Custodian Cannot Be Found
_____Exempted By Statute Other Than The Freedom of Information Act
_____Other
Signature:_______________________ Title:____________ Date:____________
NOTICE: You have the right to appeal a denial of this application to the Clinton
County Administrator 137 Margaret Street Plattsburgh, NY 12901 Who must fully
explain the reasons for such denial in writing seven days from receipt of an appeal.
I HEREBY APPEAL.
Signature:______________________________ Date:_______________________
CCSO – 002 (Revised 10/2014)
