115
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by; Chris Masterson 0
Christine Fulton ~
Sue Rose 0
Date Received: 5" / ICf / 12-
FOIL Ser. #: 115'
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DEPARTMENT:
ASSESSOR 0
ACCOUNTmG 0
CODE ENFORCEMENT 0
PLANNING 0
ZONmG ~
FIRE mSPECTOR 0
HIG~AY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGmEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
~ !il Iv
Date Received by Dept
Department Head approval:
Date:
(init)
Date Applicant Contacted: .2./9-/ /D
Date FOIL fulfilled or denied: s;J~
Closed by: ~
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Notes:
Amount Due:~~es for a total ofS ---.--.- ....
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF REtlRD:
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FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record(s) described above
o 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
o I request that the records be sent via e-mail to the address listed above
o I request that the records be faxed to the number listed above