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Chris Masterson 0.'
Christine Fulton .~
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
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FOR INTERNAL USE ONLY
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Received by:
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Date Received:
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DEPARTMENT:
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FIRE INSPECTOR ~o~ 'irh'\,
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RECEIVER OF TAXES 0 \_\
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SUPERVISOR 0 , '
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DOG CONTROL OFFICER 0 ' ·
TOWN ENGINEER 19"; - I b r-
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FOR DEP ARn..1ENT USE ONLY
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Department Head approval:
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Date Applicant Contacted: _1_'_
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Closed by:
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Name: "Oe,..",g. $0",\(.-(,"\1-.\ le. 0 check here if you are
Address: S~ N~"" ~t.t "P6.1t... requesting that the records
Ad-If"'. MA.. "\7"1...0 be mailed to this address.
Agency or firm: t-\y,l.....o - (",,,':,.C',,,~(.,,,.+I\I "'Tt.l.t...
Telephone#:('77r) "t6~ -.!1o"llf FAX#: (97$ )J.li- ""'1'0
Email address:J.4Ao.\t.$.."!rof.I1 ,,: f 0" _"",+",1. (a.....
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FORMAT OF RECORD (if available)
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1 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