146
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Chris Masterson 0
Christine Fulton ~
Sue Rose /0 0
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Received by;
Date Received:
FOIL Ser. #:
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DEPARTMENT:
ASS
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNEY 0
Name:
Address:
FOR DEPARTMENT USE ONLY
Date Received by Dept 1- / 2~ / 10
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Department Head approval: f1J-
(init)
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Date Applicant Contacted: _ / _ / _
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Date FOIL fulfilled or denied: _ / _ /
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Closed by:
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Date:
Notes:
Amount Due:
Pages for a total of $
o check here if you are
requesting that the records
/?-b'Yt) be mailed to this address.
Agency or firm: S e
Telephone#: (et.J5JJ:f2..-7if/O FAX#: ( )_-
Email address: 13 cltm E)./ (J,../f ~ C:/J1R-/i- , 00 hL
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
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