091
Date Received:
Chris Masterson 0
Christine Fulton ~
Sue Rose (5.1
!L / 1.':1) 1!!-
119/
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR ~
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
0'< .;N~~/"",
.$.'~%l' .' ':..~": ~.6>\
'0/. ,"'"P\
'I.....!' ~ .
.''0.. \,~' . . ,..}~)
,c:. . I Z:.
.;;. /.Jt...1
(I",;, .:./~/
''7("ss''c()~'"
FOIL Ser. #:
FOR DEPARTMENT USE ONLY
Date Received by Dept !l./ / Y: /0
Department Head approval:
Date Applicant Contacted:
(init)
/ /
---
Date FOIL fulfilled or denied: _I _I Ad .
Closed by: ,e ~-~
~ If; It/
IX' cf. ;(S~-=-
Date:
Notes:
Amount Due: _ Pages for a total of $ I ~ S-
Name: ,- 0 ~
Address: .? J ~~
,~
Agency or firm: Fq w V ~ t-l ~'1" 0 r0
Telephone #: (c50 ) .JuS - 2 '2 J 3 FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
)--
~IC DESCRIPTION OF REQC;>l}]1j D
of'CC/1~ ;25<"cJ~~ (
FORMAT OF RECORD (if available)
o I request to be notified when 1 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