Please print this form and complete as instructed.
City of Rochester
Records Access Application
(Please print or type)
Date:______________________________
Print
Name:_________________________
Representing:________________________
Telephone:__________________________
Address:_____________________________
____________________________________
____________________________________
Signature:_____________________________
I hereby apply
to inspect and/or copy the following record(s):
__________________________________
__________________________________
__________________________________
____________________________________
____________________________________
____________________________________
Return completed application to:
Records Access Officer
Bureau of Communications
City Hall, Room 202A
30 Church Street
Rochester, New York 14614
FAX (716) 428-7069
There is a $.25 per page charge for
copying most records. For more information on public access to records, call 428-7135.
For agency use only
________________________________________________________________________
Approved
Denied
Record not
Maintained by City
Record Access Officer:
____________________________________
Date:________________________________
For appeal only
________________________________________________________________________
If you wish to appeal the Record
Access Officer's decision on your application for public access to records, sign below and
send this form within 30 days to:
Corporation Counsel
City Hall, Room 400A
30 Church Street
Rochester, New York 14614-1295
