199De~.28.2012 10:00 AM ZEN Design Consultants, I 845 5&8 0366
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Received by: Christine Fulton t-1
Jessica Fulton
Date Received: 1 ~/~ / ~~-
FOIL Ser. #:
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DEPARTMENT: ._
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING L_l
ZONING U
FIRE INSPECTOR ~1
HIGHWAY CI
RECEIVER OF TAXES (~
RECREATION ^
SUP;~RVISOR ^
TOWN ClJ)1.RK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN E~.NCrINEER C.1
TOWN ATTORNEY CJ
PAGE. 1/ 2
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T4 WN OF 'VVAPPINGER
Application .for Public Aecess to Records
FOIL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept /
Department Head approval:
17 E ~' »? (init)
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Date Applicant ContacKe~,~t „~ / _ /
Date FOIL fullxlle~l or denied: ~~~'~r~~~°,~; 'r-
Closed by;
Date: / /
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Notes: ~- MG ! _L ~~~..~
Amount Due: _ Pages for a fatal of $~
Name: '~ ` ~ check here if you are
Address: requesting that the records
be mailed to this address.
Agency or firm;
Telephone #: ( ) - ,FAX #: ( ~~-~
Email address: ~ ,~ ~
.FORMAT OF RECORD (.if available)
1 request to be notified when I can come to inspect the record(s) described above
C) 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
I..I 1 request that the records be sent via e-mail to the address listed above
r~ I request that the records be faked to the number listed above
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