055
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose V
3- /l.i) JJL (:)
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. #: 1.c;5
DEPARTMENT:
ASSESSOR 0
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
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept 3 / li / LfL
Department Head approval:
Date Applicant Contacted:
(init)
/ /
Dale FOIL fulfilled orffred: _I _I _
Closed by: JA' L3 - I 9 - J 0
/
Date:
/
/
Notes:
Pages for a total of $
Amount Due:
SWCIFIC DESCRIPTIO OF RECORD:
CO ~r-e5 )1 ~
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
FAX #: ( ) -
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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