118
Received by:
Chris Masterson 0
Christine Fulton V
SueR~e, 0
5-. /q::J / tL
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Ser. #: } J 'I
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Date Received:
DEPARTMENT:
ASSESSOR If
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 5/~1 00 I 0
Department Head approval:
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied:
/
/
Closed by:
W5
Date:
/
/
Notes:
o check here if u are
requesting that the records
be mailed to this address.
Amount Due:
Name: .
Address:
Agency or firm: Jjc t.f I; h JI'h? 1,14-'VV rim c e
Telephone#: (tY~)!:a!L- j:?~{; FAX#: ( )_-
Bmail address:
SPECIFIC DESCRIPTION OF RECORD:
3 S Y S ~,:l/'eL !Ld
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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