APPLICATION FOR PUBLIC ACCESS TO RECORDS
Suffolk County Department of Audit and Control
SECTION 1: TO BE COMPLETED BY APPLICANT
INSTRUCTIONS TO APPLICANT: Please complete this form and send it to the FREEDOM OF INFORMATION OFFICER.
If you are mailing this form, please send it to: If you are emailing this form, please send it to:
SUFFOLK COUNTY DEPT. OF AUDIT AND CONTROL COMPTROLLER@SUFFOLKCOUNTYNY.GOV
ATTENTION: FREEDOM OF INFORMATION OFFICER
H. LEE DENISON BUILDING – 9
TH
FLOOR
100 VETERANS MEMORIAL HIGHWAY
P.O. BOX #6100
HAUPPAUGE, NEW YORK 11788-0099
I HEREBY REQUEST A COPY OF THE FOLLOWING:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
If more space is necessary you may attach additional sheets of paper.
If you have requested a list of names and/or addresses, will the list be used for commercial or fund raising purposes:
YES: ___ / NO: ___ DATE OF APPLICATION: _____________________________
_______________________________________________________________________________________________________________
Signature of Applicant and Printed Name Party Applicant Represents (if applicable)
_______________________________________________________________________________________________________________
Applicant’s Mailing Address
SECTION II: FOR USE BY FREEDOM OF INFORMATION OFFICER ONLY
□ APPROVED
□ RECORDS NOT POSSESSED OR MAINTAINED BY THIS AGENCY
□ RECORDS CANNOT BE FOUND AFTER DILIGENT SEARCH
□ DENIED. REASON FOR DENIAL: _____________________________________________________________________ ____
□ RECEIPT OF THIS REQUEST IS ACKNOWLEDGED. The approximate date by which a determination will be made is on or
about __________________________. (If more than twenty (20) business days, state reason for delay and a date certain for
response).
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
________________________________________________________________________________________________________________
(Signature) (Printed Name) (Title) (Date)
SECTION III: NOTICE TO APPLICANT
YOU HAVE THE RIGHT TO APPEAL A DENIAL OF THIS APPLICATION IN WRITING TO THE OFFICE OF THE COUNTY
ATTORNEY WITHIN THIRTY (30) DAYS OF THE DENIAL. INFORMATION AS TO THE PERSON TO CONTACT IS SHOWN
BELOW. THE CONTACTED PERSON MUST RESPOND TO YOU, IN WRITING, WITHIN TEN (10) BUSINESS DAYS OF THE
RECEIPT OF YOUR APPEAL.
ADDRESS FOR APPEALS ONLY – USE ADDRESS ABOVE FOR ALL OTHER REQUESTS:
SUFFOLK COUNTY ATTORNEY
ATTENTION: FOIL APPEALS OFFICER
H. LEE DENISON BUILDING – 6
th
FLOOR
P.O. BOX #6100
HAUPPAUGE, NEW YORK 11788-0099 SCEX FORM 8
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