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Forms Can Be Submitted via Email to lmcconolo,ueLtownofwa ingea�-li ,�ov or
vrobinson(Lxitownotwappiriberny.gov or in person/via mail to 20 Middlebush Rd '' ' pltit�'
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni -i
Lori McConologue 1
Grace Robinson F
Date Received: / 1
FOR, Ser. 4;
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING]
CODE ENFORCEMENT
HIGHWAY
❑
RECEIVER OF TAXES
11
RECREATION
El
SUPERVISOR
❑
TOWN CLERK
El
WATER/SEWER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
0
TOWN ATTORNEY
❑
TOWN OF VY AL" P NTER
Application for Public Access to Records
�- L REO VEST
UMC ng e art,..,it
TOWN OF VtAPPtNGER
FOR DEPARTMENT USE ONLY
Date Received by Dept 10
Department Head approval:
(init)
Date Applicant Contacted: 1 /go/ OS
Date FOIL fulfi[led or denied: 16 I/ a
Closed by:
Date:
Notes:
p
Amount Due:.,,. - Pages for a total of $
Name:check here if you are
Address: r� requesting, that the records
be marled to this address.
Agency or firm: I 4C
(30
Telephone 4: ( + ` - FAX #: ( } - 06
Email address:s »/"
S CIFIC DESCRIPTION OF REC RD:
i
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 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—Y I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above