069
FOR INTERNAL USE ONLY
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Chris Masterson
Christine Fulton 0
Sue Ros~ 0
5..1 dd / -1.12
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by:
FOIL Ser. #: ~ i
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0 ./"
CODE ENFORCEMENT [t('
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ /;?S / 10
Department Head approval: ~
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Closed by:
rdenied: 3 / ~!..-/ /0
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Date:
3 /'2S/ 10
Notes:
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Amount Due: f
Pages for a total of $
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
Agency or finn: c
Telephone #: (1yr) 29) - Z-)Y/ 1&: ('irV,,-) ~- 2.?YI
Email address:.C.ic
SPECIFIC DESCRIPTION OF RECORD:
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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
g/" 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