041
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ,n/
3-IL() / ~ 6
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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 0
ACCOUNTING 0
CODE ENFORCEMENT V
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 ATIORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
Date Applicant Contacted: s:1. I Lk/ /0
Date FOIL fulfilled or denied: .;J II c1 I/O
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Closed by:
Date:
Notes:
Amount Du . _ Pages for a total of $
Name: At tA Cvr7fY2~'9
Address: Vi (2 i v {~;/t-(v>, IL
N7f1t7fCt --;;1 /252';
Agency or firm: (;V'E. ( CHti.
Telephone#: (1"1::) ~():r.;. ~:>~ FAX#: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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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