167
~~,~~, ~~~~ ~VI_~
,J,.....~__~~~~
t 1 I ....., ''-'.....11'01 ..., ,.....
~.
-II.
I..
f;..1.
~:"i
!:5
~;;}
.....~ .
~
;:",
FOIL Ser. #:
Chris Masterson 0.'
Christine Fulton .~
S\lf Rose 5
~/ii.l/()
/ro3 th~/~~
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
,; ~
FOR INTERNAL USE ONLY
~::
Received by:
o-~\
,.
....
DEPARTMENT:
ASSESSOR 0" - I G, ~
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING Er' - J" ~.
ZONING 0 _I ~i' }
FIRE INSPECTOR ~o~ 'ir\.;I,
HIGHWAY 0
RECEIVER OF TAXES 0 L\
RECREATION D~~\310
SUPERVISOR 0 , '
TOWN CLERK ?S 8'" - / b ~
WATER/SEWER 6 ~ rJ:d} ~f,
DOG CONTROL OFFICER 0 - ,.. ~
TOWN ENGINEER ~; - J b r
TOWN ATIORNEY 0
.\ . ,,"
'S,'
, ~-t
;--
.;~~'f.~.'HAPi>'1'+"
I~" ~ . ..,"(-"
;1::-". . '. ..-1'>'
,I.:' ~. ,I)
',0\. .; >,
,c. .' ~
.,....^ . . ..lo...J
.'" .." . A.!.
.~. s' .....;.....,~/
.<;C. _s _~o'V"
:}
Date Received:
~:,1
,.
.';...
....
."
:J
FOR DEPARTMENT USE ONLY
,.
~I:.:
1:',.'
;~:
:.-;..
"
".;
Name: ~ o""~-.c''''.\le. 0 check here if you are
Address: S y. tJ 4", S t. -\-- 'f'6.1t.. requesting thatthe records
A c. ~, M t\ 0 \ 7 "Z..O be mailed to this address.
Agency or firm: t-\y'!~o - (",,,':rc:-,,,~c."'+l\1 .,.-t.Lt....
Telephone #: ('711) '1.6~ ~.!1o"'lf FAX #: (ern) J.li- "'1 "(0
Email address: JOAo'\t.S'" A...Df."":'.,,,.....~"'+"'1. (0.....
te Received by Dept
Jj-e1rtment Head approval:
I I
Date Applicant Contacted:
Date:
I I
~:.~
Notes:
Amoun.t Due: _ Pages for a total of $
',1..
"
'-
".
FORMAT OF RECORD (if available)
U
..,: 0
~~
,
n
0
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 r~cords be faxed to the number listed above
~tJG?-~ JL- ~/? /~d..