Incorporated Village of Northport
224 Main Street
Northport, NY 11768
Tel (631) 261-7502 Fax (631) 261-7521
Please complete the following:
Name: ______________________________________ Telephone: __________________
Representing: ___________________________________________________________
Address: _______________________________________________________________
Signature: ____________________________________Date: ______________________
[ ] I hereby apply to inspect the following records
[ ] I hereby apply for a copy of the following records (Please note copy fee may apply)
Detailed description of document/record requested:
NOTICE TO APPLICANT: You have the right to appeal a denial of this application in writing within 30 days of the denial.
Please address your appeal to the Mayor. You will receive a reply within 7 business days of receipt of your appeal.
[ ] Approved [ ] Denied
[ ] Receipt of this request is acknowledged. There will be a delay in supplying the requested record
until ___________ for the following reason: _____________________________________
Denied for reason(s) checked below:
[ ] Record cannot be located [ ] Record exempt by law [ ] Record does not exist
[ ] Unwarranted Invasion of Privacy [ ] Confidential Disclosure [ ] Other ____________
Signature: _________________________ Title: ____________________ Date: ________
Pursuant to the FOIL, the Village of Northport has five business days to make the record available, deny the request and
inform the party of the right to appeal, or to certify in writing that the municipality does not have possession of the record
or that the record cannot be found after a diligent search. If approved, the Village of Northport will provide the requested
documents no later than 25 days from the date of request.