123
FOIL Ser. #:
Chris Masterson
Christine Fulton
Sue Rose
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
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
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Date Received:
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted: V / l.-- / /0
Date FOue9 denied: hi l-- I / {)
Closed by: II{ 0
Date: ~/--LI ~
Notes:
Amount Due: 1/.lSPages for a total of$ 5 (~/~
Name: V l ~ c: .f rl ~ (' G 0 ....J ..a...1 0 check here if you are
Address: (t:::. S f ~ v--CJL. Qr- - ~ requesting that the records
H S~ 1<::,- f 1.-... L rJ i' {LS '2.. Y be mailed to this address.
Agency or firm: P/!.'--....d~,PI L r b./2- L.r p~,~ (J.f\-o::.~~
Telephone#: (<1('( )~- l.{ ""'? 7FAX#: ( )_-
Email address:V.1N"\. <:. Cs-..::. ,-.) c. t-- @ I\~ "- ,~
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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
V 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