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148
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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lye
Received by:
Date Received:
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
~
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WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
ON
SUPERVISOR
TOWN CLERK
Date FOIL fulfilled or denied: / /
Closed by:
.
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Date:
Notes:
Amount Due:
Pages for a total of $
Name:
Address:
o check here if you are
requesting that the records
/1lb'<1tJ be mailed to this address.
Agency or finn: S e
Telephone#: ( e'-IYJ 2!IL.-7L//o FAX#: ( )_-
Email address:l3enmE.}./ t+ If € c: /J1 H/1-. ( 00 hL,
SPECIFIC DESCRIPTION OF RECORD:
/) l.L lIo l{C,{1elr-S w;1h 8; lIs c. \A~ (!!:>r reSfol1d<=:Vl~€.- M 3-
fJ-1;j-;rrE('ri~RZ;!IJ;;{ YYlIIv't..( rEs f!6/4 t)..o JO-RII1a.IJ
4.A/D J9.u Cl(c -eJti 1- B)/I..s
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
