283
Date Received:
Chris Masterson
Christine Fulton
Sue Rose
JL/ 3-/.tL
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V/
2009-10-16 JCM
TOWN OF W APPlNGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING ~
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 ATTORNEY 0
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FOIL Ser. #:
FOR DEPARTMENT USE ONLY
Date Received by Dept II / J / II
Department Head approval:
(init)
Date Applicant Contacted: LL. / 2 / 1/
DateFOEfulfi~denied: I( /2/ II
Closed by: 11I')- ;! c;.-
Date: V ~~ !!.f..2.J1 J
Notes:
Pages for a total of $
Amount Due:
Name: \~~ui~ ~Y\uv~
Address: l 1 \.0 \~ t LC.. \ -'0 LlO "'" ~~
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm: 'SC\6 'S~run:~ ~ "'"
Telephone #: (c; ~l )fu-- 'J~"'" ~ FAX #: ( )_-
Email address: ~ I~U jo..J f\'\ ~ l-I/t..luFft e ~ 4~. .c 0 "'"
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
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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
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