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FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ / ~~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING 0
CODE ENFORCEMENT ^
PLANNING
ZONING
FIRE INSPECTOR ^
HIGHWAY p
RECENER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
Name:
Address:
2009-10-16 JCM
TOWN OF WA.PPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / 2 ~~
Department Head approval:
(init)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: _ / _ /
Closed by: L
Date: ,j /~dZ/r~j
Notes: ~,~. ~~~~ ~1t~
Amount Due: ages for a total of $
Agency or firm: ~ ~ " J
Telephone #: ( ) ~Z- ~,~ .~ FAX #: ( ) _
Email address:
^ check here if you aze
requesting that the records
r be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
FO/RMAT OF RECORD (if available)
C~' I request to be notified when I can come to ins ec
p t 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