128FUR INTEIiNAI. USL ONLY
Received by: Michael Leonard
Jessica Fulton y'~
Date Received: ~ 11
FOIL Ser_ #:
DEPARTMENT:
ASSES50R
ACCOUNTll~TG ~~
COD:!/ ENFORCENLENT ^,
PLANNING
ZONING ~
TYRE INSPECTOR. lJ
1-1.IGHVVAY
RECEIVER OF TAXES I~
RECREATION I
S~LJPERVISOR CJ
TOWN' CLERIC !1
WATERlSE~VER C1
'170G CONTROL UF!~ICER U
TOWN ENGINEER r1
TOWN ATTORNEY f I
Name:
Address:
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? 009-1 ~-16 J'CM
T(aWN ~F APPINGER
Application far Public Access to 17,ecords
F'Ol'~ RED NEST
FOR DEFARTMENT USI; ONLY
Date Received by Dept _ f ,,, / _
Department F$ead approval:
(iriit)
Date Applicant Contacted- _,,,_ I _„ f
Date FOIL fulfilled or denied: ~ l I
Clased by:
Date: ~ / ~7f ~~_
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Notes: ~~ Im f-v ~ ~ ~ ~~`~r+1J .
Amount Due: Pages for a total of $________
l~ chock here if you are
~, - requesting that the records
P be mailed to this address,
Agency or Firm: ~ ~ C ~ t ~ ~ ~~ ~' „~, ~ .
Telzphone #: ( } t - FAX #: { ) ~~ ~
'Email address:
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Y'
FORMAT O1~ RECORD (if available)
l-1 I request to be notified when I can came to inspect the record(s) described above
C7 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 dais application
l..l I requGSt that the records be sent via c-mail to the address listed above
~~ !request that the records be faxed to the number listed above
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