045
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
Date Received:
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FOIL Ser. #:
DEPARTMENT: _ /
ASSESSOR IiY
ACCOUNTmG 0
CODE ENFORCEMENT 0
PLANNmG 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER, 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied:
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Closed by:
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Date:
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Notes:
Amount Due: ~ Pages for a total of $ 0- S'D
Name:
Address:
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be mailed to this address.
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Agency or firm: cl.-L l.::' "- lA- ( 4.h
Telephone #: (~I r) 2.-" L.. l' jJ:J FAX #: (
Email address:
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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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