110
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Chris Masterson ~
Christine Fulton
Sue R{.q D 0
Date Received: 05/ /!-
FOIL Ser. #: -LID
DEPARTMENT:
ASSESSOR
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGH1VAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W ATERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
~/
of( y.JAP,.1.
.~~~. ..~~,It~. '.
.:o! ....':\~..
I'" : .. ~ \
. .. .\~'
...t:J,~,\ .j
.'~'. 12:
, .... . 1",./
':"~i .-..... ~<...~/
ss co'"
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / I ') / J..Q
Department Head approval:
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied:
/
/
Closed by:
~
Date:
/
/
Notes:
Amount Due:
Pages for a total of $ ~
.
Name: ...,
Address:
Agency or firm.: ~ \.{ 1;- h4-n ~4-1Il./ r e. h c. e.
Telephone #: (8 "Is-) it.2:-- ) r >b FAX #: ( ) --
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: /
11S--J/7 )4(/ ~.f?~J
A rr?1'.e~ C~A ~)~; /,0
r . .
~'/ / ~./
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