012
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Chris Masterson 0
Christine Fulton 0
Sue Rose 0
Date Received: L /!Jt / ~
FOIL Ser. #: 1T \ y
DEPARTMENT:
ASSESSOR 0
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
Department Head approval:
/ /:<? / u
- 9.:--Y.
(init)
Date Applicant Contacted:
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/ /
Date:
/ /
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Date FOIL fulfilled or denied:
Closed by:
Notes:
-
Amount Due: StJ t Pages for a total of $ I Su q
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Name: K 0{ '"1I'f' I c:;;,. \ r. \
Address: '2-0 ~ S q U VY'\. R- ~
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o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone#: Cb\.t'5) L\-\.to_ "='~~ 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