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2. 
4. TOWN OF SOUTHAMPTON

   Application for Public Access to Records
   Please type. 

6. Name of Requester*
8. Name of Requester Business
10. Address of Requester*
12. Telephone Number of Requester*
14. Email Address of Requester*
16. Name of Client Represented
18. I hereby request (Check One Only)*

    1. To inspect the records described below
    2. Request copies of the records described below, and agree to pay all applicable fees for those copies
    3. Request scans via email of the records described below
20. Name of Southampton Department (Division) you are seeking record/file from
22. Date Range of requested item:
24. Check Property Information
    https://gis.southamptontownny.gov/parcelsearch/
26. Address/tax map number (Parcel-specific records)
28. Resolution/Decision Numbers (boards)
30. Any other info that will help locate the records*
32. By Checking This Box*

    1. I agree

    I hereby state that any property owners’ names and mailing addresses requested by me and/or disclosed by the Town in regards to the aforementioned FOIL request, will not be used for solicitation or fund-raising purposes. Furthermore, I will not make available the names and addresses to any other person, organization, or entity for the purpose of engaging in solicitation or fund-raising. Furthermore, I agree that the record(s) requested shall not be utilized in any manner tending to constitute an unwarranted invasion of personal privacy. I further agree to indemnify and hold the Town of Southampton harmless from damages and/or any claim arising from any such unauthorized use of the record(s) requested. 

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34. Submit

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