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Forms Can Be Submitted via Email to lmcconologlu,cktownoty�lin �cni. ov or
grobi isonEvtoyLnofwa in ern ov or in person/via mail to 20 Middleb
FOR INTERNAL USE ONLY
Received
Received by: Joseph P. Paoloni 11
Lori McConologue i'�JUL 0 1 ZOZ4
Grace Robinson F!
Date Received:
FOIL Ser. #:
DEPARTMENT:
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ASSESSOR
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ACCOUNTING
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CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
RECREATION
F-1
SUPERVISOR
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TOWN CLERK
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WATER/SEWER
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DOG CONTROL OFFICERE1
TOWN ENGINEER
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TOWN ATTORNEY
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12590
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Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
(1-nff�
Date Applicant Contacted: 5 /.(g 1,2q
Date FOIL fulfilled or denied: 5/ Iq I Qq
Closed by:
Date:
Notes:
Amount Due: — Pages for a total of $
Name check here if you are
Addrilss: c requesting that the records
oij e -U -4,C Aj be mailed to this address.
Agency or fin -n:
Telephone #: (Y,t �T3 FAX #;
Email address:�cz L77_
SPECIFIC DESCRIPTION OF TORD:
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Mrs
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FORMAT OF RECORD (if available)
IH 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 e-mail to the address listed above
I request that the records be faxed to the number listed above