129
FOIL Ser. #:
Chris Masterson 0
Christine Fulton /I
S}l~ Rose 0
~$)m
Jag
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
Date Received:
DEPARTMENT:
ASSESSOR
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 ATIORNEY 0
')?
FOR DEPARTMENT USE ONLY
Date Received by Dept La- / a'i .J.Q
Department Head approval:
Date Applicant Contacted:
(init)
/ /
---
Date FOIL fulfilled or denied:
/
/
Date:
~
fLftJ./( 0
Closed by:
Notes: ~~
Amount Due: t5 Pages for a total of $ J 'd- S-
Name:
Address:
(d irQ check here if you are
-Y requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: ~3 ) --
Email address:
FAX #: (
)--
SPECIFIC DESCRIPTION OF RECORD:
~~
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