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Forms Can Be Submitted via Email to lmcconolo rte4WAz0xk M]"i&erny.gov or
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Received by: Joseph P. Paoloni I
Lori McConologue 7
Grace Robinson
Date Received: I
FOIL Ser. #:
DEPARTMENT:
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I request to be notified when I can come to inspect the record(s) described above
RECEIVER OF TAXES
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RECREATION
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
SUPERVISOR
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TOWN CLERK
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DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
Date Applicant Contacted:
Date FOIL fallflled or denied: I ✓
Closed by:
Date: I f
Notes: ! rr
Amount Due: — Pages for a total of
Name: y I 1 []check here if you are
Address: 13 requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: ( } - FAX #: ( )
Email address: + , __m.._ I A -(L , GOl~C`--.
SPECIFIC DES RIPTI0N QF RECORD:
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FORMAT OF RECORD (if available) &3,557 - /- -e5lSy
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 e-mail to the address listed above
I request that the records be faxed to the number listed above