059
Received by:
Chris Masterson 0
Christine Fulton 0
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
DEPARTMENT:
ASSESSOR
ACCOUNTING
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
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Date Received:
FOIL Ser. #:
FOR DEPARTMENT USE ONLY
Date Received by Dept 3 6l3r1f2
Department Head approval: _
(mit)
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied:
/
/
Closed by:
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Date:
Notes:
Amount Due'
Pages for a total of $
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
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Agency or firm:
Telephone#:(SI.I.>) 76~- ()'J..7'; FAX#: ( )_-
Email address: ~ro~ br, H~ O~6~ ~ At' d..Ll .fY\.
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SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
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I request to be notified when I can come to inspect the record(s} described above
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
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above
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