| Name: |
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| Firm: |
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| Address: |
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| City: |
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State: |
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Zip: |
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| Email: |
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| Telephone: |
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| Access to and a photocopy are requested of the following
record: |
| |
| Borough: |
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Block: |
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Lot: |
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| Year(s) record filed: |
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| Request Type: |
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Application for correction with all other documents attached |
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Application for correction only (2 pages) |
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Form TC201, Income and Expense Statement only (2 pages) |
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Notice of Offer and Acceptance Agreement (TC70) |
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Other. Identify record requested as specifically as possible below. |
| Other: |
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| |
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