10306/28/2012 11:03 4857083
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FOR INTERNAL USE ONLY
Received by: Christine Fulton U ,
Jessica 1~ultoan g
Date Received: ~ ! ~/
FOIL Ser. #: ~ ~~~,,
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DEPARTMENT:
ASSESSOR l~
ACCOUNTING 0
CODE ENFORCEMENT L~
PLANNING ~,
zoN1NG ~
FIRS INSI'~cTOI~ ~
HIGHWAY ~
RECEIVER OF TAXES ~
RECREATION C7
SUPERVISOR ^
TOWN CLERK ~
WATER/SEWER 7
DOG CONTROL OFFICER L7
TOWN ENGINEER
TOWN ,t~TTORNEY (J
Pa~E 02
Zaag-lo-1G JcM
TOWrT OF WAFP~NGER
Application for Public Access to Records
FOIL .R,EI~, tTEST
~a.~r$uS~Z48-IH7~
FOR DEPARTMENT USE ONLY
Date Received by Dept (~ / ~ / _~
Department Head approval:
(init)
Date Applicant Contacted: ~ ~ / ~ a-
Date FOIL fulfilled or denied: ~„ / ~- / I ~
Glosed by: f~i,2.,°r
Date: ~ / ~- / I a- ..
Notes:
Amount Due: ,~„ Pages fnr a total of $ --
Name: MQ,1;56~a,'p~,n } z, CJ check here if you are
Address: 2ti ~e-v;~ k~ , requestiaag that the acecords
p ~R~ }~,~~ : ~ , ~ ~{ 1'~~ U 3 be mailed to this address.
AgerACy ox firm: ~ t 5
Telephone #; (~~IS y52, - ly~~ AX #: (8+t5 ) y~~ - 08 3
Email address: r},. t ass rem eD .~ cas ., S~a...~rs 5# rv.~r ~: ~5 . ~ a ~'^
FORMAT OF RECORD (if available)
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 an the back of this application
Cl 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
06f28/2012 11:03 485083
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PAGE 01
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TRANSMITTAL DOVER SHEET
TQ: Records ACOess Officer PAGES: 2 (including cover sheet}
FAX: 845 298 1478
FROM: Melissia Pentz; Ecosystems Strategies
DATE: June 28, 2012
RE: FOIL
ESi Job Number: CW12115
COMMENTS:
Please see attached far FAIL request-
cc: File
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