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FOIL Ser. #:
Chris Masterson 0
Christine Fulton . 0
Sue Rose )('
2-1 19--1 Jil.
1/77
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTiNG ~
CODE ENFORCEMENT ~
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
mGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMrnNT USE ONLY
Date Applicant Contacted:
J I /021 fu'/~'
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Date Received by Dept
Department Head approval:
Closed by:
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Dare:
Notes: ~-
Amount Due:
Pages for a total of $
Name:\tJt'rdj ~i evilc.z. 0 check here if you are
Address: .2 5 G:Jy-p~r1 Ve... requesting that the records
S U I'te c..., ~ II .J[f, 1\\'1 I ;l53~ be mailed to this address.
Agency 01' firm:~ r:~~eenY'4 pU-G
Telephone#: (i45)mR O~ FAX#: (g45)~ROO41--
Email addl'ess: e- ' ri n , axYl
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
~ I request to be notified when I can come to inspect the l'ecord(s) described above
o I request co pies of the records described above and agree to pay the cost of sllch records in
accordance with the fee schedule on the back of this application
o I l'equest that the l'ecords be sent via eRmail to the address listed above
o I request that the l'ecords be faxed to the number listed above