Application for Public Access to Town of Bethlehem Records

Date:*

Submitted To:

Town of Bethlehem Records Management Officer

Submitted By:*

Representing:

Mailing Address:
    Including City, State & Zip

Email Address:*

Telephone Number:*

Fax Number:

I hereby apply to inspect the following records:

OR

I hereby apply for copies of the following records at a cost of 25 cents per page:

NOTICE: Any person denied access to a record may appeal, within 30 days, in writing, such denial to the Town Supervisor.

If you prefer not to fill this form online,

Printable Application

you may complete the printable application and return to Nanci Moquin, Town Clerk’s Office FOIL Request, Bethlehem Town Hall, 445 Delaware Avenue, Delmar, NY 12054.

For Police Records requests, mail to Records Office, Town of Bethlehem Police Department, 447 Delaware Avenue, Delmar, NY 12054 or e-mail Records@TownOfBethlehem.org