057
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose d
.J / J-2 / -1!2-
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #:
57
DEPARTMENT:
ASSESSOR ~
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNEY 0
FOR DEPARTMENT USE ONLY
3 / /5/!!!-
Date Received by Dept
Department Head approval:
Date Applicant Contacted:
-
(init)
/ /
---
Date FOIL fulfilled or denied:c=J / ,,- /
Closed by: ~
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Date:
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Notes:
Amount Due: /1 Pages for a total of $
Name: (Y) 1(" hCt e I KCl FF
Address: J / l> CV ;' POI-C. k P...,. k i? ,-
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Agency or firm.: 1- l5 {,... I :I '" c...
Telephone#: (9/1{ ) tJLL-~I.J11tf F~#: (q/~ ) ~,C;t{ - s-7-'-I'1
Email address: i tiJ L ' Cofrl
)( check here if you are
requesting that the records
be mailed to tbis address.
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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