Town of Ramapo
237 Rt. 59, Suffern, N.Y. 10901
845-357-5100 PHONE 845-357-8513 FAX
APPLICATION FOR PUBLIC ACCESS TO TOWN RECORDS
Records Access Officer: Sharon M. Osherovitz, Town Clerk
Town records are open for inspection Monday Friday 9am to 5pm
I HEREBY APPLY TO INSPECT THE FOLLOWING TOWN RECORD(S):
Full Name (Print)
Signature
Address
City/State/Zip
Daytime Phone
Date of Request
Email Address
THERE IS A CHARGE OF $.25 PER COPIED PAGE ALLOWED BY LAW
BELOW FOR TOWN USE ONLY
( ) Request Approved ( ) No Charge for Record ( ) Charge
( ) Request Denied for the Reason(s) below:
( ) Confidential Disclosure
( ) Part of Investigatory Files
( ) Unwarranted Invasion of Personal Privacy
( ) Record Not Located
( ) Record not Maintained by this Agency
( ) Would impair contract awards/collective bargaining agreements
( ) Trade secret, confidential commercial information
( ) Law enforcement records
( ) Exempted by Stature other than the Freedom of Information Act
( ) Other (Specify) _______________________________________________________
________________________________ __________________________ _______________________
Signature of Town Rep. Title Date
NOTICE: Any person denied access to records may appeal the denial within 30 days of the denial. Such appeals
should be addressed to the Supervisor of the Town of Ramapo, 237 Route 59, Suffern, NY 10901.
I HEREBY APPEAL: ( )
Certification Fee:
Photocopy Fee:
Total to be Paid:
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