161
FROM :SAMY
FAX NO. :2274291
Jul. 29 2010 12:52PM Pi
Received by:
Chris Masterson 0
Christine Fulton .~
Sue Rose 0
(ll/af1/ &.
) LP I
2009-1O-16ICM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL RE()UEST
FOR INTERNAL USE ONLY
Date Received:
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT ~
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FIRE INSPECTOR 'g'"
IDGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR .~
TOWN CLERK '11 .
WATER/SEWER ~
DOG CONTROL OFFICER ~
<tOWN ENGINEER :::E-J
TOWN ATTORNEY' 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
7 /:J-O-V l lJ
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(init)
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. Date Applicant Contacted:
Date FOIL fulfilled ore l/1:fJJ -1Q
Closed by: 13 G
Notes:
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Date:
Amount Due: / Pages for a total of $ /
Name:
Address:
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requesting that the records
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Agency or firm: ~
Telephone #: ( U') ~S'-
Email address: V .lJ
FORMAT OF RECORD (if available)
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I request to be notified when I can come to inspect the record(s) described above
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
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above
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