041
FOR INTERNAL USE ONLY
Received by:
CIirisMasterson 0
Christine Fu1ton ~
Sue Ro~C(. 0
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Date Received:
FOIL Ser.#:
DEPARTMENT:
ASSESSOR . 0
ACCOUNTING 0
CODE ENFORCEMENT ,,0 {.
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. ZONING 0
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. 'FIRE INSPECTOR 0
HIGHWAY :(
RECEIVER OF TAXES
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W ATERlSEWER 0
DOG CONTI,.tOL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNEY 0
Name:
Address:
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2009-10-16 JCM
TOWN OF ~W APPINGER
Application for Pu;plic Access to Records
FOIL~Qr;EST'
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FOR DEP ARTMENTUSE ONLY
pf.lte Received by Dept
Department Head approval: d
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(init)
Date Applicant Contacted: /.' /
Date FO~~ denied: ~ I <t I I z...
Clo~ed by: ,y> N\-
Date:
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---
Notes:
Amount Due: ~ Pages for a .total of $ '-I: OD
. '"i:."
o check here if you are
requesting that the records
be mailed to this address.
I
FORMAT OF RECORD (ifavailable)
.,t 1 request to be notified when 1 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 1 request that the records be sent via e-mail to the address listed above
o 1 request that the records be faxed to the number listed above