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140SEP-18-2012 01:40 FROM:
FO_ R 1N'fERNAL USE ONLY
Received by: Christine Fulton
Jessica. Fulton
Date Received; / ,(~ ~ / ~ a
FOIL Ser. #: ~~~ .
DEPARTMENT:
ASSESSOR
ACCOUNTLNG f )
CODE L•NFORC'EMENT fpQ
PLANNING n
ZONING i ~
FIRE 1NSPECTOK I..I
1.1.1GHWAY CJ
!tl/CEJVEIt OF TAXES CJ
RECREATION LJ
SUPERVISOR {]
TOWN CLERK C1
WATER/5 h WER (1
DOG CONTRn[., OFFICER CJ
TOWN ENC.fNEER L I
TUWN ATTORNEY n
T0: 92970579 P.2~7
200y-10-'I 6 JCM
TOWN OF WAFPINGER
Applicat7on for Public Access to Records
FOIL .REQUEST
1! OR DEPARTMENT USE ONj~Y
Dace 12eccived by Dept
DepArhncnt Head approval:
Date .Applicant Contacted:
Date F0 ful ~ e ~r denied:
Closed by;
Date:
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nit)
~ ~i9/ao~v
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Notes: l 3 mil' a
Amount .Due: ~ Z' Pages 1''i~r n total oi' $ S
Name: ~~~r E ~u 2r{ E,~„ IJ check here if you are
Address: i~1~~N ~1 requesting that the records
`(~ 121e~3 be mailed to this address.
Agency or firm: Jc t7~c.'IUl~.._~,
Telephone #: (Qy~) y~~_'~~ FAX #: (S'~S )!-I13 -oZ~o7-
Email address; 1~T r r-.er'@~'t n kt~-.r-t~_C,yw~ ,
s-~>wc.lrlC DESCRIrTION OF RECORD:
Grt.~ # 1?~~ a9_
FORMAT OF 12FCORD (it'availablc)
~., I request to be notif cd when 1 can come to inspect the record(s) described above
^ J request copies of the records described above and agree to pay the cast of such r.~cords in
accordance with the fee schedule on the back of this application
i I 1 request that the records be sent via a-mail to the address listed above
U 1 request that the records be f:-xed to the number listed above
