178
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 1>f
~~ Rose 0
U.Q113/ JD
1'/f3
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0 FOR DEPARTMENT USE ONLY
ACCOUNTING [Y
CODE ENFORCEMENT 0 Date Received by Dept L ~ 0
PLANNING 0 Department Head approval: -
ZONING 0 (init)
FIRE INSPECTOR 0 Date Applicant Contacted: I /
HIGHWAY 0 ---
RECEIVER OF TAXES 0 Date FOIL fulfilled or denied: I /
RECREATION 0 ---
(fl-/3-/0
SUPE Closed by:
TOWN CLERK ~
W A TERlSEWER Date: / /
---
DOG CONTROL OFFICER 0 Notes:
TOWN ENGINEER 0
TOWN ATIORNEY 0 Amount Due:
o~ vJ~PI
l'~', ,~.~'"
,o! ' , '. ~.,),
'I- '(' "
IO'\~'~,' ,"\>-",'1
c;... ' i~
,4J< J ..1
C' " ,.. .....'
~It~ss-co~+ .
Date Received:
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
FAX #: (
)--
oHdence
FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record(s) described above
o 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
o I request that the records be sent via e-mail to the address listed above
o I request that the records be faxed to the number listed above