020
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose g
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2009-10-16 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 ~
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 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 DEPARTMENT USE ONLY
Date Received by Dept lL / l 1 I 0
Department Head approval:
(init)
Date Applicant Contacted: _ 1 _ 1 _
Date FOIL fulfilled or denied: d2 1 () :v -LO
Closed by:
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Date:
Notes:
Pages for a total of $
Amount Due:
Name: 1., Lt '- f D- e. j17);J Ii ;::;;; :eJl '. check here if you are
Address: / () 9 7 000 hf'l() n.d c..- ; requesting that the records
C (1 J a brr c; ~ I N C rOff Y b 7 be mailed to this address.
Agency or firm:
Telephone #: <9/0 ).:il!L- 7.3,.9'1 FAX #: (
Email 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
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