042
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
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2009-] 0-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Ser. #:
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTrnG 0
CODE ENFORCEMENT 0
PLANNING 0
ZONrnG 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
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Date Applicant Contacted: .:s / J (J / / 0
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Date FOI~ denied: ZL / LeJ / L1!-.
Closed by: /loifevtL
Date Received by Dept
Department Head approval:
Date:
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Amount Due:
Pages for a total of $
Name: N iJ S (2 (Jt-r "'.IN & f1 f2 7'
Address: ~ ';l..t) P L I( '.':1-
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Agency or firm:
Telephone #: (9/7 ) 55'? - 705/ 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