122
Received by;
Chris Masterson 0
Christine Fulton' )9-
Sue Rose 0
5~IIO
10d
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
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FOIL Ser. #:
DEPARTMENT:
ASSESSOR tJ
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 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 DEP ARTMENT USE ONLY
Date Received by Dept S J)( m (
Department Head approval:
Date Applicant Contacted:
(init)
1 1
Date FOIL fulfilled or denied: _I _I _
~c)
Closed by:
Date:
Amount Du :
o check here if you are
requesting that the records
be mailed to this address.
Notes:
Name: 5' I:t S;f-n ,n//.o/
Address:
Agency or firm: Ifr,r4/;:h~ ~r-#nc.e
Telephone #: (r ysi k:f:L- ~? ~ FAX #: (
Email address:
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SPECIFIC DESCRIPTION OF RECORD:
? .-(J 7/a elf'i'1 4c rtz.'] D /C
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