124
FOR INTERNAL USE ONLY
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2009-10-16 JCM
TOWN OFW APPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Chris Masterson tJ/
Christine Fulton 0
Sue Rose 0
Date Received: & / 0 L\ / ..1Q
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR ~
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES r
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept {; / c;/ / ~ (0
Department Head approval:
Date Applicant Contacted:
(init)
/ /
Closed by:
/ /
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Date FOIL fulfilled or denied:
Date:
/
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ame: C /'
Address:/rv~t.L 12-~ SL/Jrtn-- !(JD
Agency or firm: k (p-L G,L- LJ"7!!f:, "" ~ ?Y
Telephone#: (if">) 2.~<f - RJo) FAX#: ( )~-
Email address: Ato-n;:>'T.4 (aJ 6h/l-r~ - ~o;,
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Notes:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record(s) described above
o 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
o I request that the records be sent via e-mail to the address listed above
o I request that the records be faxed to the number listed above