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010 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: ~ / d1J / ;lt11 U FOIL Ser. #: --rf/O DEP ARTMENT: ASSESSOR 0 ACCOUNTING 0 CODE ENFORCEMENT 0 PLANNIN G 0 ZONING 0 FIRE INSPECTOR 0 HIGHWAY 0 RECEIVER OF TAXES 0 RECREATION 0 SUPERVISOR 0 TOWN CLERK 0 W A TERlSEWER 0 DOG CONTROL OFFICER 0 TOWN ENGINEER 0 TOWN ATTORNEY 0 FOR DEPARTMENT USE ONLY Date Received by Dept Department Head approval: -l / r;$X.;/ 2P' 0 ~ Date Applicant Contacted: --- / / --- / / Date: yj(3 I ti)/dfj 5}rj}O Notes: __:d Amount Due: ~ Pages for a total of $ o check here if you are requesting that the records be mailed to this address. Agency or firm: Telephone#: (<6<./$ ) ~q'6 -4lf41 FAX#: ( ) Email address: '0 i'yY) I ("e.tA lJ;J-/ @.. a 0 J ' SPECIFIC DESCRIPTION OF RECORD: FORMAT OF RECORD (if available) ~ 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 o o