070
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Date Received:
Chris Masterson 0
Christine Fulton ~ J
Sue Rose 8
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J7D
2009-]0-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #:
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DEPARTMENT: ~
ASSESSOR FOR DEPARTMENT USE ONLY
ACCOUNTING
CODE ENFORCEMENT 0 Date Received by Dept 3/c;bj{]
PLANNING 0 Department Head approval:
ZONING 0 (init)
FIRE INSPECTOR 0 Date Applicant Contacted: / /
HIGHWAY 0 ---
RECEIVER OF TAXES 0 Date FOIL fulfilled or denied: I I
RECREATION 0 -~
SUPERVISOR 0 Closed by:
TOWN CLERK 0 ~W
W A TERlSEWER 0 Date:
DOG CONTROL OFFICER 0 Notes:
TOWN ENGINEER 0
TOWN ATTORNEY 0 Amount Due: _ Pages for a total of $
Name: ~ ~/rMt&
Address: <:D. ro~~
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Agency or finn: ::Y~ S
Telephone #: (;<l~ ) 1!L- ~d~ ~ FAX #: (
Email address: . 0.. . u. w..~f/^ i rS . v
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD:
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