136
Received by:
Chris Masterson 0
Christine Fulton "'f/
ill LJ6 / /D 0
) 3UJ
2009-] 0-] 6 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE lNSPECTOR 0
HIGHWAY 0
RECENEROFTAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
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Date FOIL fulfilled or denied:
/
/
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Closed by:
Date:
7L/cf(/~
Notes:
Amount Due:
Pages for a total of$
Name:~~ S?fjf~1: Z o check here if you are
Address: .. Hl. hll/e requesting that the records
. 1+ 'P" I AI trP"S. r rt I k s be mailed to this address.
Agencyorfinn: tSel;r I~O- 3d]
Telephone#: (P;4~)~ivl'lIO FAX#: ( )__
Email address:SeA/)1Etl:-A(;I(J-.!l1RI ~ ' Co IX
SPEC7IC DESCRIP:hON OF RECORD: J
/11 tL"" t-/. c.. e I- 5 (,.() / f1" bills -a.. v-.~ c:. ,0 r "e.s po h d €.I?t e M;;8
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