060
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF W APPlNGER
Application for Public Access to Records
FOIL REQUEST
Received by:
Christine Fulton 0
Jessica Fulton ~
Date Received: !::L / .5 / ~
FOIL Ser. #: -::f=J C[)
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
o
o
o
o
o
o
o
o
o
o
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FOR DEPARTMENT USE ONLY
Date Received by Dept t.j I~. . q
Department Head approval: _
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Date Applicant Contacted: _ / _ / _
Date FOIL fulfilled or denied: Ii / S- / I ~
Closed by: $
Date: ' /. . /
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Notes:
Name:
Address:
Amount Due: _ Pages for a total of $
Agency or firm:
Telephone #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
)--
FAX. #: (
)--
SPECIFICI>ES~TION OF~ ~.
/fYlUr'-" ^, <1 ~ I <tCo'lrrp ~ ':
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