051
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose 5
3-1 Jk 1 ./..fL
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #: , i:) J
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DEPARTMENT: _/
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ACCOUNTmG 0
CODE ENFORCEMENT 0
PLANNING 0
ZONmG 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION , 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGmEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Applicant Contacted:
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(init)
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Date Received by Dept
Department Head approval:
Date FOIL fulfilled or denied:
1
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Date:
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Amount Due: -L2- Pages for a total oi$ 0
Name: ~c)15~" ?E:"i"'6t~<
Address: 10 l2 \. b t,. ~ -RoA.{)
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o check here if you are
requesting that the records
be mailed to this address.
Agency or finn:
Telephone #: (8'15) 227 - cq~~ ( FAX #: (
Email address:
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SPECIFIC DE~CRIPTION OF RECORD:
?77 Wije-Re'1t f+,,-\.. OAD
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