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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR INTERNAL USE ONLY
Chris Masterson 0 ,
Christine Fulton .~
Stlf Rose 5
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Received by:
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Date Received:
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FOIL Ser. #:
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DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER B'" - / G 7
DOG CONTROL OFFICER 0
TOWN ENGINEER ~ -I b r
TOWN A TIORNEY 0
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: ....R I -.!:L 11I.l.-
Closed by:
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Date:
Notes: fJ6 (ij)plt~ trlllJJ.,
Amount Due: ....a.- Pages for a total of $ 0
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Name: 1Je.""'1l $ OrY\(.'C"V', \ l e.. 0 check here if you are
Address: Stf' tJ ~'" st.\- 'f'e..1t... requesting that the records
A t h",. M A. 0 \ 7 "LO be mailed to this address.
Agency or firm: t\y,lt'"o - (,",,,':rC',,,~c.""+lI.l "'-t.LL...
Telephone#: ("771') ~6~ -.!1o"flf FAX#: (q-n )~- ~q"fO
Email address: J.04>,""t..$~ L...I.I.l..ol2." ,,: f "" ....""+"'1. (tJ.....
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FORMAT OF RECORD (if available)
1 request to be notified when I can come to inspect the record(s) described above
I request copies ofthe 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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