120. ~
FOR INTERNAL USE ONLY
Received by: Town Clerk n
Zessica Fulton +~
Date >Received: ~ / ~ ~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
.ACCOUNTING Q
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
1-IIGHWAY C3
RECEIVER OF TAXES ^
RECREATION Q
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
Name:
Address:
Agency ar firm:
Telephone #:
Email address:
}
2009-10-16 7CM
TOWN Off' WAPPYN~GER
Application for Public Access to Records
Fart, RE~uFS~
FOR DEPARTMENT USE ONL'Y'
Date Received by Dept ~, /~,.L / ( 3
Department Head approval:
(init)
Date Applicant Contacted:
Date 1~O1L fulfilled or denied:
I I
gl~l~
Closed by:
Date:
~1~11 t3
Nates: ~ e d Q Ir
Amount Due: Pages far a total of $,~,
^ check here if you are
r requesting that the records
be mailed to this address.
c~ C~ )
FAX #: (~`/(~ )~g~ -~~ I
FORMAT OF RECORD (if available}
17 I request to 6e notified when I can come to inspect the record(s) described above
I request copies of the records described above and agree to pay the cost of such records in
accordance with the fee schedule on the back of this application
^ I request that the records be sent via a-mail to the address listed above
C'I I request that the records be fared to the number listed above
E0JZ0 3~Jt1d H~31~t~/1 E09LLL89Z5 0b ~6T 800ZIZTIOT