025FEB-28-2013 20:27 FROM:MARYANN W1LL1HM5
rOR i1yTFRNAL~1 JSE ONLY
Received by; Christine p'ulton
Jessica Fulton ~
Date Received: ~ I ~ / ~3
FOIL Ser. #: G~.S
DEPARTMENT:
ASSESSOR D
ACCOUNTI.NCr D
CODE ENFORCEM.E.NT
FLANNIlVG D
zortn+tc ^
FIRE INSPECTOR ^
I-I1.GH.WAY I~I
RECEIVER OF TAXES n
RECRE'ATI(7N f'1
SUriEItV'1SOlt Q
TOWN CLERK ;~ '
WATER/5EWER (~
D04 COIJTROL OFFICER n
TOWN ENGINEER ^
TOWN ATTORNEY U
2009-10.1b JCM
7'C~7WN OF WAP~'LNGER
Application for Fablia Access to Records
Fars ~~~~sT
FOR DEPARTMENT USF ON ~Y
Date Received by Dept •,~ / ,~ /
Department Hcad approval: ~~
(mot)
Date Applicant Contacted: (> / ~ / ~ .3
bate 'FO fulfilled denied: ~ / / / l 3
Clasad by: ___!~'LL
Date: .~ ~ / ~.3
Notes: ~~~~~ ~ ~~ s ~ ~' 7~
Amount Duc: Pages for a total of S _
Name: ~~~~ ,~~~~ 1 ~ i' ~, Yn ~ ^ check here if you ere
Address: requesting that the records
~ be mailed to this address,
Agency or firm; S E s
Telephone #: (~ ~) ~, ,~Q FAX #: „~ ) ~~-i~~~
Email address: '
SPECTIr C DESCRIPTION F RECORD: ~ 1
,c ~u . e ~ d ~' ~. ~ d h Qr
~ '
~ t d~~~ ~~
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 recar¢~ described above and agree to pay the coat of such records in
occoxdnnce with the fee sahedwie on the bnck of this application
GY 1 request that the .rccard.~. be sent via c-mail to the address listed above
^ I. request that the records be ;faxed to the number listed above