103
,
FOR INTERNAL USE ONLY
Received by: Chris Masterson 0
Christine Fulton _~./
Sue Rose ~,
Date Received: i la!l /.J.Q.. u
FOIL Ser. #:
I 0 ~ -.l- J ()''S
DEPARTMENT:
ASSESSOR .- I Q '~
ACCOUNTING 0
CODE ENFORCEMENT 0
PL~ING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES ~ /u'~
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied:
/
/
Closed by:
~~
Date:
.!:L / ~ /1.2-
Notes:
Amount Due:
Pages for a total of $
Name: ~5~f2-pn0rl) f. L S (~ [/U~
Address: / '70 / R-I-..I "'),~ SUi T [ {O 0
'[7''511 k; I! Ju1/ /;;; S-3-Lf
Agency or firm: 7< 'lJ-l ell. (j1JJLL "HI1'5 f<(4Z \
Telephone#: (<.5'-fD.a:iL- :rrco FAX#: (&4:;-) ae;
Email address:
o check here if you are
requesting that the records
be mailed to this address.
.: $590 2-
SPECIFIC DESCRIPTION OF RECORD:
C~,,~! ~ '--r-;Y-//J / Y D
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