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grobinsoll �ttownofwa Or III personm0 M
/via ail to ?CJ Rd WappinN
gers Falls, Y 12590
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FOR INTERNAL, USE ONLY
Received by: Joseph 1). Paoloni
Lori MCC0r10I0gUe
Grace Robinson
Date Received:
FOIL Sen 4.1
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
El
RECREATION
1:1
SUPERVISOR
0
TOWN CLERK
1:1
WATER/SEWER
Ej
DOG CONTROL OFFICER.
0
TOWN ENGINEER
1:1
TOWN ATTORNEY
11
TOWN OF WAIPPIN"CER
Application for Public Access to Records
FOIL RE ST
E34ding Department
T11n 0 WaPPinger
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
(init)
Date Applicant Contacted: qJ-d/1
Daic FOI Ifulfilled - �r denied: dd-1 XR, S -
Closed -by:
Date: 1 92
/71
Notes:
AMOUnt Due: Pages for a total of S
Name: Ocheck here if you are
Address ii)t y_.2W,N requesting that the records
be mailed to this address.
Agericy or finn.:___
Telephone t; 15 lv4, FAQ: #:
Email address:
J, L
, -k- j -
SPECIFIC' DESCRIPTIC)N OF RECORD:
FORMAT OF RECORD (if available) � - &) 736;
IH request to be notified when I can come to inspect 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 e-mail to the address listed above
1 reqUeSt that the records be faxed to the number listed above