074
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
. FILE copy
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FOR INTERNAL USE ONLY
Received by:
Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT ~
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNEY 0
Date Received by Dept
Department Head approval:
FOR DEP ARTMENT USE QNL Y
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~init) ell.
Date Applicant c:ontacted: If I ~ /,0
Date FOlL fulfilled or denied: _ r-:::;::r -
Closed by: /I tf
Date: ( it II~I /0
Notes: N~ .A~~",u4/<i -
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Amount Due: _ Pages for a total of $
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: ~4
Email address:
FORMAT OF RECORD (if available)
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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
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