Chemung County · County government
Chemung County government forms
22 forms published by Chemung County offices. You can download these and submit them yourself; none of them need a notary.
Chemung County forms (no notary required)
No notary requiredApplication for On-Site Wastewater Treatment System PermitProperty owners or contractors use this application to request a Chemung County permit for a new or replacement on-site wastewater treatment system.
No notary requiredApplication for Sanitary Waste PermitChemung County property owners use this application to request a sanitary sewer connection, repair, or cap-off permit for a building.
No notary requiredAuthorization for Release of InformationThis form lets a client authorize Chemung County Department of Human Services to obtain or release specified information to a named person or organization.
No notary requiredBusiness Contact FormThe Chemung County Sheriff’s Office Business Contact Form collects business, manager, and contact details from businesses submitting the form.
No notary requiredFirearms License Public Records Exemption RequestThis request lets firearms license applicants and license holders ask that information about their application or license not be made public.
No notary requiredFood Service Establishment Permit ApplicationFood service operators submit this application to Chemung County Health Department to request a permit for a food service establishment.
No notary requiredFreedom of Information Law RequestThis request form lets applicants seek access to Chemung County Health Department records by inspection or by paper or electronic copies.
No notary requiredHIPAA AuthorizationIndividuals or their personal representatives use this form to authorize the Chemung County Insurance Department to use or disclose protected health information.
No notary requiredIndividual Access Pass ApplicationNew York State residents with qualifying disabilities use this application to request an Individual Access Pass for eligible parks, historic sites, and recreation facilities.
No notary requiredLandlord StatementChemung County landlords or their agents complete this statement to verify a tenant’s rental arrangement and provide housing details to the Department of Social Services.
No notary requiredMunicipal Referral FormChemung County municipalities use this form to refer proposed land-use actions to the Chemung County Planning Board for review.
No notary requiredNew York State Application for Certain Benefits and ServicesThis application lets individuals and households apply for public assistance, food benefits, child care, Medicaid with other programs, and certain services through their social services district.
No notary requiredOther Insurance Coverage InformationChemung County employees or subscribers use this required form to report other health insurance coverage for themselves and eligible dependents.
No notary requiredPermit for Temporary Use of Right-of-Way (Special Events)Organizations use this permit application to request temporary use of Chemung County roads for a planned special event.
No notary requiredPistol/Revolver License Recertification FormThis form lets pistol or revolver license holders provide personal, license, and firearm information to recertify a license in Chemung County.
No notary requiredPlanning Board Member ApplicationThis application is for people interested in serving on the Chemung County Planning Board and must be submitted with a resume.
No notary requiredRenewal or Transfer Application for On-Site Wastewater Treatment System PermitProperty owners use this application to extend an on-site wastewater treatment system permit or request its transfer after an ownership or contractor change.
No notary requiredReport of Address ChangeThis form reports a change of address and is completed by a person who needs to update their address with the county.
No notary requiredRequest for Taxpayer Identification Number and CertificationThis Form W-9 lets an individual or entity provide a requester with taxpayer identification details and tax certifications.
No notary requiredResidency & Household Composition VerificationThis form records who lives in a dwelling and is used by applicants or recipients to verify residency and household composition for county assistance cases.
No notary requiredSocial Services Information Request FormChemung County residents use this form to request copies of their records from the Department of Social Services for a specified time period.
No notary requiredTemporary Food Service ApplicationChemung County’s Temporary Food Service Application is for operators seeking a permit to serve food at a temporary event or seasonal location.