308
-
FOR INTERNAL USE ONLY
Received by;
Chris Masterson 0
Christine Fulton Xi
~ue Rose 0
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2009-1 i
TOWN OF W APPIN(
Application for Public Access to I
FOIL REQUEST
Date Received;
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
FOR DEPARTMENT USE ONLY
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FOIL Ser. #;
Date Received by Dept
Department Head approval:
/Z / /2.. / "loll
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------
(init)
Date Applicant Contacted:
/ /
---
Date FOIL fulfilled or denied: / /
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Closed by: (; 1-/
Date: /2... / / L / /01/
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Notes:
Name: 1:0<.)( I ~ ~L
Address: _:0 (VII--O"-'OO\> 'R., ([IS 7'1C)
k>4fp(JI4J(/')~S~s, N. '-1. :l.s-Jo
Agency or finn;
Telephone#: (~cf!r)~-~ft,S-;L FAX.#; ( )__
Email address: v"Z:..e- '2. 7 ~'p 'if I ~ v6R ( zo AJ . I\J ($:..r
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Amount Due: _ Pages for a total of $ t 50
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
'PI<" p,,-,,<<-7Y Z N i<C""-m 4T,,, rv Co R~?ie at taSI".!!?- t! ~(yt'es ~"k4<:-
FORMAT OF RECORD (if available)
o /l request to be notified when I can come to inspect the record(s) described above
/i}/ I request copies of the records descnbed 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