What can I request with this form?

You can request to inspect records, receive paper copies, or receive electronic copies by email. The form asks you to describe the information sought, including relevant subjects, dates, facilities, or locations.

How do I submit the Freedom of Information Law request?

The form says to submit by mail, fax to 607-737-2059, or email to EHS@chemungcountyny.gov. It lists the Chemung County Health Department at 103 Washington St., PO Box 588, Elmira, NY 14902-0588.

Do I need a notary for this Freedom of Information Law request?

No. The form provides a signature and date line but no notary block. It does not identify an attachment or related step that must be notarized or sworn.

Is there a fee for copies?

The form states that a copy fee of $0.25 per page may apply to paper copies. It includes spaces for the number of pages, cost per page, total cost, and payment details.

Chemung County, NY · Chemung County

No notary required

Freedom of Information Law Request

This request form lets applicants seek access to Chemung County Health Department records by inspection or by paper or electronic copies.

At a glance

Issued by: City of Chemung County · Chemung County, Chemung County, New York
Notarization: Not required: file this form without a notary.
Official source: chemungcountyny.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form lets applicants ask the Chemung County Health Department to inspect records or receive paper or electronic copies under the Freedom of Information Law. It asks for contact information, the type and specific subject of the records, the requested delivery option, a signature, and date. Paper copies may cost $0.25 per page; the department uses the remaining sections to document search results, access denials, and copy costs.

Who needs it

Anyone seeking to inspect records or request paper or electronic copies from the Chemung County Health Department can complete this form.

How to submit it

Submit by mail, fax to 607-737-2059, or email to [email protected]. The form lists the Chemung County Health Department at 103 Washington St., PO Box 588, Elmira, NY 14902-0588; paper-copy fees of $0.25 per page may apply.

About notarization

This request is signed and dated without a notary; the form does not identify any attachment or related step that must be notarized or sworn.

How to submit this form

1
Download the Request
Download the Chemung County Freedom of Information Law request form.
2
Complete the Form
Provide your contact information, describe the records specifically, select an access or copy option, and sign and date the request.
3
Gather Attachments
The form does not specify any required attachments.
4
Submit to the Department
Send the form by mail, fax to 607-737-2059, or email to [email protected].

Frequently asked questions

What can I request with this form?: You can request to inspect records, receive paper copies, or receive electronic copies by email. The form asks you to describe the information sought, including relevant subjects, dates, facilities, or locations.
How do I submit the Freedom of Information Law request?: The form says to submit by mail, fax to 607-737-2059, or email to [email protected]. It lists the Chemung County Health Department at 103 Washington St., PO Box 588, Elmira, NY 14902-0588.
Do I need a notary for this Freedom of Information Law request?: No. The form provides a signature and date line but no notary block. It does not identify an attachment or related step that must be notarized or sworn.
Is there a fee for copies?: The form states that a copy fee of $0.25 per page may apply to paper copies. It includes spaces for the number of pages, cost per page, total cost, and payment details.

Need something notarized?

This Freedom of Information Law Request doesn’t need a notary, but if you have another Chemung County form that does, a commissioned online notary can help.