075
Received by;
Chris Masterson
Christine Fulton
Sue Rose
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
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FOIL Ser. #:
DEPARTMENT: \ /'
ASSESSOR &r
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
W ATERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: ~ / <;;" / ~
Closed by:
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Date:
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Amount Due: -12.... Pages for a total of $ (")
Name: )
Address:
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requesting that the records
be mailed to this address.
Agency or firm: /:lot 4 (; It 154"9 (~~- e-Q//
Telephone #: ( ) ~- :; 1'..';6 FAX #: ( )_-
Email address: '
SPEC~IC DESC~IPTION OF ~~ORD: ,; /
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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