Fillable SAG HARBOR VILLAGE POLICE DEPARTMENT (Incorporated Village of Sag Harbor)

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SAG HARBOR VILLAGE POLICE DEPARTMENT (Incorporated Village of Sag Harbor)

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The SAG HARBOR VILLAGE POLICE DEPARTMENT (Incorporated Village of Sag Harbor) form is 1 page long and contains:

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  • 12 check-boxes
  • 18 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Incorporated Village of Sag Harbor

BROWSE INCORPORATED VILLAGE OF SAG HARBOR (NY) FORMS

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SAG HARBOR VILLAGE POLICE
DEPARTMENT
70 Division Street, PO Box 660, Sag Harbor, NY 11963
Tel: 631-725-0247 Fax: 631-725-5660
APPLICATION FOR PUBLIC ACCESS TO RECORDS
Section I: To be Completed by Applicant
I hereby apply for a copy of the record/report described below
To: Central Records
Sag Harbor Village Police Department
70 Division Street
PO Box 660
Sag Harbor, NY 11963-0015
Applicant’s Name (First, Initial, Last)
Applicant’s Phone Number
1. Check either Motor Vehicle Accident Report Other Report/Record (Describe Below)
2. Description of report or record (If other than a Motor Vehicle Accident Report)
3. Name(s) of Driver(s)
4. Name of Complainant
6. Date of Occurrence
9. Location of Occurrence
Section II: For Use by Freedom of Information Officer Only
Approved
Denied (for reasons checked below)
C
onfidential Disclosure Record not Found Exempt by statute
Part of Investigation File(s) Record not Found Other
U
nwarranted Invasion of Privacy Record not Maintained
Freedom of Information Officer Signature
Mail Report To:
Applicant’s Address
Applicant Represents
Applicant’s Signature
5. Name of Victim
7. Date Range if More Than One
8. CC Number
Title
Date
You have the right to appeal a denial of this application in writing to the office of the Village Clerk at 55
Main Street, PO Box 660 Sag Harbor, NY 11963-0015 within (30) thirty days of the denial.
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SAG HARBOR VILLAGE POLICE DEPARTMENT (Incorporated Village of Sag Harbor)

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Completed 19 January 2021

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