053
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Chris Masterson 0
Christine Fulton 0
Sue Rose ~
Date Received: .1LI IYI ~
FOIL Ser. #: 63
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DEPARTMENT:
ASSESSOR 0
ACCOUNTmG 0
CODE ENFORCEMENT 19/
PLANNING 0
ZONmG 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEP ARTMENT USE ONLY
Date Received by Dept 31 ffi / ()
Department Head approval:
(init)
Date Applicant Contacted: 3 1 I Y1 / t?
DateFO~ordenied: .311 &'1 /0
Closed by: .' fi)
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Date:
3 11'f 1 /0 "
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C:75
Pages for a total of $ ~
Notes:
Amount Due:
Name: ~pbPr+ KIA'" ~ I Sv-
Address: 4// Kif" by+nw,,- <Rei
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Agency or firm: .
Telephone#: (VI/'! ):2.1!L-:JQCJo FAX#: ( )_-
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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
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