158FOR INTERNA,~. USE ONL'Y'd
Received by: Michael Leonard ~I
Jessica Fulton ^
Date Received:. / ~,,. / ~.
r 3 `~
FOIL Ser. -#:
DEPARTMENT:
,A~S~ESSOR ~-
ACCOUI~I'TING 0
CODE ENFORCEMENT ^
PLANNING 0
ZONING ^
FIRE zNSPECTOR ^
RECEIVER OF'T,A,XES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK 0
w.A,TER/SEWER ^
ooc CaNTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
aoa~-la-x~ rcM
TOWN OF WAFP~NCER.
Application for Fublic Access to Records
FDIL REQUEST
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FOR DEPARTMENT USE DNLY
Date Received by Dept ~ ! ..~ / ~„j ~
Depaxtxr~ent Dead approval: _
(i nit)
Date Applicant Caz~tacted: ~ ~ ! ~ / ~3
Date FOIL fulfilled or denied: ~ I ~- I ~
Closed by: L ~
Date: ~J~I (3
Notes: _~ l~ CP~-~Y'~ ~SC~-~x-u.c~1 -~
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Amount Due: Pages foz a total of $
Name:
Address:
Agency or firm: !`tll V fI.U~ ~
Telepk~or~aP #; (E74•~~Qy~,
Email address: rfAU.z~ ~:
^ checlt here if you axe
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
I request to be natifzed wlaeta I can came to inspect the record{s) described above
D I request copies of the records described above and agree to pay the cost of such retards in
accordance with the fee schedule on the back of this application
~ I raquaet that tl~o roeardq bo ~w,t vim a Tn1iI tQ ~o ~dd~oee ~ietad ~bova
I request tlxat~tk~e records be faxed to the number listed above