160FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING ^
ZONING
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER 0
TOWN ATTORNEY ^
Name:
Agency or firm:~~/fin
Telephone #: (~~)
Email address: fQ~~rrvE.,
2009-10-16 JCM
TOWN OF VVAPPINGER
Application for Public Access to Records
FOIE REQ UFST
FOR DEPARTMENT USE ONLY
Date Received by Dept /'~ / / ~ / / 3
Department Head approval: ~_Fr-
(init)
Date Applicant Contacted: / / / ~/ ~~
Date F fulfilled r denied: / /
Closed by:
Date:
Notes:
~/ ~--
~~ ! ~~ /
Amount Due: Pages for a total of $
^ check here if you are
requesting that the records
be mailed to this address.
#: ( ~ -
~~ ~ ~~ o ~~
SPECIFIC DESC)ZIP~~ON 03REC0 OS3 7~
FORMAT OF RECORD (if available)
I request to be 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
I request that the records be faxed to the number listed above