Please complete this Freedom of Information Law (FOIL) Application for Public Access to Government Records and
submit it to the Village Clerk. The Village of Johnson City will grant access to records, deny access in writing, or
acknowledge the receipt of your request within five (5) business days.
Department from Which Record(s) Sought: _________________________________________________________
Date/Address of Incident (if applicable): ____________________________________________________
Description of Records Sought (Be Specific): _________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
I would like a copy of the record(s)
□□ I would like to review the record(s)
Requestor’s Name: ______________________________________________________________________
Address: _______________________________________________________________________________
_______________________________________________________________________________________
Phone Number(s): _(H)_____________________(C)______________________(W)__________________
Email Address: _________________________________________________________________________
Photocopies of regular and legal sized documents are available at a cost of $0.25/page. CDs, DVDs, maps
and certain other records are available for the actual cost of reproducing such records. If the records are
stored electronically, the Village may be able to respond with the requested material via email at no charge.
If this request is approved, I would prefer to receive notification by: Email: □ Letter: □
Signature: ___________________________________________________ Date: ______________________
Please note that your application may be Approved, Approved with Deletions or Denied. The Village of Johnson City may deny your request for the following
reasons, in accordance with Public Officers Law, § 87(2): (Item 1) Exempt by State or Federal statute; (Item 2) Unwarranted invasion of personal privacy; (Item
3) Would impair present/imminent contract awards or collective bargaining negotiations; (Item 4) Records are trade secrets; (Item 5) Compiled for law
enforcement purposes which would interfere with law enforcement negotiations; deprive a person of a right to a fair trial or impartial adjudication; identify a
confidential source or disclose confidential information relative to a criminal investigation; or would reveal criminal investigative techniques/procedures; (Item 6)
Would endanger the life or safety of any person; (Item 7) Are inter-agency or intra-agency communications; or (Item 8) Are examination questions or answers
requested prior to final administration of such questions. You have a right to appeal a denial of this application to the Village Clerk, 243 Main Street, Johnson
City, NY 13790. The Village of Johnson City will explain the reasons for such denial in writing within ten (10) business days of an appeal.
PLEASE NOTE: If an applicant has requested to inspect records and does not respond to the Village within two (2) weeks, the Village will consider the request as
having been withdrawn. If an applicant has requested copies of records and does not respond and pay for such items, any subsequent requests will not be
considered until payment is received.
OFFICE USE ONLY
Approved: □ Approved with Deletions (Cite Item No.): □ Denied (Cite Item No.): □ Record Does Not Exist: □
Notes:________________________________________________________________________________________
___________________________________________________________________________________________
Signature:__________________________________________________________ Date: _______________________________
VILLAGE OF JOHNSON CITY
243 Main Street • Johnson City, NY 13790
Application for Public Access to Records
(Freedom of Information Law)
