169
07/01/2010 12:10
9142323812
WILLIAM A KELLY CO
PAGE 02
Received by:
Chris Masterson 0
Christine FUltonk
Sue Rose I-.n A IJ
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2009.10- I 6 .leM
TOWN OF W APPTh'CrER
Application for Public Access to Records
FOIL REOUEST
FOR INTERNAL USE ONLY
FOIL Scr. #:
0" WAPpi
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Date Rec:eived:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING IJ
CODE ENFORCEMENT U
PLANNING ~
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ZONING
FIRE INSPECTOR [j
HIGHWAY 0
RECE1VER OF TAXES 0
RECREATION 0
SUPER VISOR 0
TOWN CLERK 0
W A TERISEWER fJ
DOG CONTROL OFFICER 0
TOWN ENGINEER [I
TOWN ATTORNEY [l
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
1 I
(init)
Date Applicant Contacted:
I I
Date FOIL fulfilled or denied:
Closed by:
Date:
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Notes:
Amount Due: _ Pages for a total of $__~
Name:~~tt'w ~~tl
Address: 1 t.cl Ee<.-L ~ .
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Agencyorfinn: W:\\~&.~ ~, ~\l", t" c.c.
Telephone #: ( crt ~ ) <<34-- FAX #: (1'1f ) ilL- 'lS, ~
Email address: · "-e.'\ eo. (t;) M
SPEC, IFlC DESCR1PTION OF R~IU): l...lol-S ~ fl".~ r.. ('
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o check here if you are
requesting that the re ~o "ds
be mailed to this address.
FORMA r OF RECORD (if available)
if
J request to be notified when r can come to inspect the record(s) described above 7 -~-
I request copies of the records described above and agree to pay the cost of such rec rds in e
accordance with the fee schedule on the back of this application
I request tt.Jat the records be sent via e-mail to the address listed above
r request that the records be faxed to the number listed above
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