I wish to inspect the following record(s): (identify records you are interested in as specific and clearly as possible) You may inspect documents first and then ask for copies of the ones you actually want. If any of the requested documents are available electronically and you don’t required printed copies, there will be no charge for those documents.

APPROVED: Date: __________________

Number of Copies: ___________

Charge: ________________


DENIED (for the reason(s) checked below)

___ Exempted by statute other than Freedom of Information
___ Unwarranted invasion of personal privacy
___ Would impair contract awards or collective bargaining agreements
___ Trade secret; confidential commercial information
___ Law enforcement records
___ Would endanger the life or safety of any person
___ Interagency or intra-agency materials
___ Record is not maintained by this agency
___ Record of which this agency is legal custodian cannot be found
___ Other ______________________________________________

Any person denied access to records may appeal within 30 days of the denial. 
Such appeals should be addressed to
Supervisor of the Town of Esopus
PO Box 700, Port Ewen NY 12466