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Forms

Where available, you can submit a form by entering information in the appropriate text fields and clicking the Submit button, or you can download forms and fill them out when it's convenient for you. Many of the forms still require your signature; please either mail or deliver these to our offices.

Please note, most Dutchess County forms are available as PDF documents. This format requires that you have Adobe Acrobat Reader installed on your PC. Click on the Adobe Acrobat Reader icon Adobe Acrobat icon to download a free copy of this software.

View All Dutchess County Forms (A - Z)

Contact

Department of Emergency Response Forms


Access to Dept. of Emergency Response Records - FOIL Application (.pdf)

The Application for Access to Dept. of Emergency Response Records - FOIL Form (.pdf) can be mailed to address listed, faxed to 845-486-3998 or emailed to ssellitto@dutchessny.gov

We will acknowledge a request within five business days of the receipt of a written request for a record reasonably described.

Full text of the FOIL can be found on the Department of State, Committee on Open Government page.

Record Access and Appeals Officers read and review the Freedom of Information Law annually

Return to:  
Records Access Officer
Department of Emergency Response
392 Creek Road
Poughkeepsie, New York 12601



Address Request Form

Use the Address Request Form (.pdf) to request a new street address from the Real Property Tax Addressing staff. (NOTE:  Do not use this form for mailing address changes.  To change your mailing address, you must contact your local assessor.)

Return to: 

Dutchess County Division of Real Property Tax Service
22 Market Street
Poughkeepsie, NY 12601

Questions? Email rptaddressing@DutchessNY.gov - or - call 845-486-2140



CAD Incident and Response

CAD Incidence and Response access is restricted to pre-approved emergency service agencies.



Collection of E-911 of Wireless Surcharge (.pdf)

Complete the Collection of E-911 of Wireless Surcharge (.pdf).  Remittance must be made no later than thirty (30) days after the last business day of the month.

Return to:
Dutchess County Commissioner of Finance
22 Market Street
Poughkeepsie NY 12601



Collection of E-911 VoIP/Landline Surcharge (.pdf)

Complete the Collection of E-911 VoIP/Landline Surcharge Form (.pdf).  Remittance must be made no later than thirty (30) days after the last business day of the month.

Return to:
Dutchess County Commissioner of Finance
22 Market Street
Poughkeepsie NY 12601



E-911 Annual Accounting of Wireless Surcharge Form (.pdf)

Complete the E-911 Annual Accounting of Wireless Surcharge Form (.pdf).  This accounting must be filed no later than thirty (30) days after the last business day of the calendar year for which the accounting is rendered.

Return to:
Dutchess County Commissioner of Finance
22 Market Street
Poughkeepsie NY 12601-3294



GIS Data Release Request (.pdf)

Any agency that makes a request for GIS Data from the Department of Emergency Response is required to first complete and submit a GIS Data Request Form (.pdf).

As stated on the form, you are acknowledging that the County of Dutchess provides this data “as-is”, and holds no liability arising from any incomplete, incorrect, inaccurate or misleading data. In addition, the requester will have no claims to data updates.

It should also be understood that this data is not “owned” solely by the Department of Emergency Response. Therefore, all primary dataset editors will be contacted by the Department of Emergency Response for their authorization to release the requested data to you. On occasions, the data release request may be temporarily denied if the editor is in the middle of an edit session. You will be contacted if any of the datasets are not available at the time of your request.

  • Return to:
    Dutchess County Department of Emergency Response
    392 Creek Road
    Poughkeepsie, NY 12601
    (845) 486-2080


Medical Reserve Corp (MRC) Volunteer Application (.pdf)

Complete the Medical Reserve Corp (MRC) Volunteer Application (.pdf).  If you need further assistance, or have any questions, please contact:

MRC Coordinator
Dutchess County Department of Behavioral & Community Health
85 Civic Center Plaza
Poughkeepsie, NY 12601
Phone: (845) 486-2493
jryan@dutchessny.gov



Training Registration Form (.pdf)

Use the Training Registration Form (.pdf) for the enrollment of students.

To ensure that all prospective students are:

  • Members of a fire department.
  • Authorized to attend the course.
  • Medically cleared to perform any Outside exercises the course requires.
  • Medically cleared to wear a self-contained Breathing apparatus (SCBA).
  • Provides accurate documentation of class enrollments, which enables us to react to low enrollment situations.
  • Provides the instructor with important information prior to the start of class.

Contact: 

Dave Walsh, Deputy Coordinator of Training
Phone: 845-242-6745
Email: dwalsh@dutchessny.gov