112
Received by;
Chris Masterson . q
Christine Fulton 'J:!
Sue Ros.,e 0
S / J C1 / /0
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1 1'2-
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Ser. #:
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Date Received:
DEPARTMENT:
ASSESSOR M.
ACCOUNTING 6'
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
5/ .t1 / .-:...L
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(init)
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Date Applicant Contacted;
Date FOIL fulfilled or denied:
/
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Closed by:
NflMr
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Date:
Notes:
Amount Due: ~ Pages for a total of $ (). ~ 0
Name:
Address:
Agency or firm: ~(It(( k~ v~r&nc~
Telephone#:(Wj~ 3'OJCFAX#: ( )_-
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: Lf- 1)4: /../l/
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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