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FOR INTERNAL USH ONLY
Received by: Christine Fulton U '
Jessica Fulton
Date Received: ~ / ~/ ~ `,
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ~
ACCOUNTING 0
CODE ENFORCEMENx L~
PLAI~INING ~9,
ZONING ~
FIRE INS)'ECTOR ~
HIGHWAY ~
RECEIVER OF TAXES
RECREATION ^
SUPERVISOR ^
TOWN CLERK ~ ,
WATERJSEWER i7
DOG CONTROL OFFICER tJ
TOWN ENGINEER
TaWN ,ATTORNEY CJ
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zoa4- l 0-16 JcM
TOWN OF WA~P~NGER
Application for Public Access to Records
FDIL ,~Q UEST
E~,nFpAkTMENT USE ONLY
Date Received by Dept _ ~ J.. I __ _ _
Department Head approval:
(init)
Date Applicant Contacted: ~ I I .~"
Date FOIL fulfilled detaie • to l~ I
Closed by:
Date: XZ ~~
Notes:
Amount Due: ,_,,,_,,,,, Pages for of $
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Name: N1~1;'~Pn ~ z, ^ aheclc here if you are
Address:'~tl "Dav ;~ k~ . requestiaag that the records
~~;;~ y~, `f rxc,a~3 be mailed to this address.
Agency or firm: ~ t S
Telepbane #: (94s qSZ -1~5~ AX #: (B+V~ ) .~5 - 08 3
Emailaddress:~1~.,":~ c 5#~a~k ; ~~- ~ o~*
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
~ I request to be notified when I can come to inspect the recard(s} described shave
^ 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 tl~e address listed above
^ I request that the records be faxed to the nurnber listed above
~~