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One City Plaza Norwich, NY 13815
Telephone 607- 334-1230 -- Fax 607-334-1208
Date of Request:
Specific Record Requested:
Date & Time of Incident (if applicable):
Specific Information Requested:
Name of Person Requesting Record:
Company:
Address:
Telephone:
Within five (5) business days the above request will be approved or denied.
Copies of approved records will be available @ $0.25 per each single page.
APPROVED ___________________ DENIED
Reason for Denial:
Signature: ____________________ Title: __________________ Date:
NOTICE: You have the right to appeal a denial of this application to the head of this
agency.
CITY OF NORWICH
NORWICH, NY 13815
Application for Access to Public Records
Please print all information clearly
Professional Fax Cover Sheet
source: norwichnewyork.net
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