095-096
2009-] 0-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Chris Masterson 0
Christine Fulton ~D
Sue Rose
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1f9f: t -# PC
Received by:
Date Received:
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECENER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: )1 I
Closed by:
/
/
Date:
/
/
Notes:
Amount Due:
Pages for a total of $
Name: l
Address:
o check here if you are
requesting that the records
be mailed to this address.
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Agency or firm:
Telephone#: (If'tr) ()t/l7- J :.I/O FAX#: (
Email address:
SPECIRI}; DESCRIPTION OF RECORD: ,r1 ~
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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