2025-357 (3)Records Datalmse 13e1'(,)i,c Submitting Request
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Date, Received by D(,pt
I load approval:
ASSESSOR
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Date Applicant Contacted
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F , UGHWAY
Closed by:
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RECRI-ATIUN
Notes:
SUPERVISC)R,
Amount Due � Pages for as total of S
TOWN CLERK
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NVATER./SENVER
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TOWN ENGINE').Hj�
T01AIN ATTORNEY
Address�
Agency or firm - _-t5n-
Telephone -#, ON --" 98>
Einall address
SPECIFIC DESCRIMION OF R.r-
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Date, Received by D(,pt
I load approval:
(init)
Date Applicant Contacted
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Date F0111 fulfi Hed or clemed
Closed by:
Date,
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Notes:
Amount Due � Pages for as total of S
check here if you are
requesting that the records
be mailed to this address,
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equest to be notified when I can come to inspect the, record(s) described above
request copies of the records described above and agree to pay the cost of sucfj records in
a
ecordance with tile fee schedule on the back of this application
f�l request tll,,.It the records be sent via e-mail to the address listed
I r uest Haat the records be faxed to the number listed above
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