115RECEI~/ED
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ / ( ~( /c~~ ~---~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING 0
ZONING ^
FIRE INSPECTOR ^
HIGHWAY - 0
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
JUG 19 202
2009-10-16 JCM
T~~ PINGER
App or~u is ccess to Records
FOIL REQUEST
FOR DEB~N'MTi' ~S>alQ~djl,~Y
Date Received by DepQ ~ Q ~ s ~ ~ / _
Department Head approval:
a~/~I~~~2i (init)
Date Applicant Contacted: _ /
Date FOIL fulfilled or denied: ~/ /
Closed by: Zl`.~.
Date:
Notes:
/ /
Amount Due- f Pages for a total of $
Name: P ~ ~~~,~ ^ check here if you are
Address: Sty N~,',~,} e requesting that the records
Pv~S~~~Nf ~ e nl y /? 40 ~ be mailed to this address.
Agency or firm: G~ rivr ~-- ~+-~~ ~ L
Telephone #: (Eu!') `4~- t 2~ FAX #: ($'~t ) ~- ~i
Email address: ~O~i~.Srw, ~ 1 wt's ~-u,u~• c ~.~.
SPECIFIC DESCRIPTION OF RECORD: ~r.,
,,
FORMAT OF RECORD (if available)
I request-to be notified when I can come to ~nspeet 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 a-mail to the address listed above
^ I request that the records be faxed to the number listed above