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Chris Masterson 0
Christine Fulton 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
LOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOlt 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING S-
ZONING 0
FIRE INSPECTOR. 0
illGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERV1S0R 0
TOWN CLERK 0
W A TERlSEWER 0
000 CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNBY 0
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FOIL Ser. #:
EQR DE' ARTMBNT USE ONt y
Date Received by Dept
Department Head approval:
(0 /13 I / ()
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(init)
Date Applicant Contacted; _/ _I _
Date fOlL~ed: _1_1_
Closed by: tJ..( {L
Date: Ie 113/ 1'0
Not~:
Amount Due: _ Pages for a total of $
Nam~11IS' ~Sl
Address: q ~ ~~t'::>~~& .
Agency or fum: Lo.<A ~~c..es () ~ <e..tva.nusJ ~ So-4I\.S
Telephone t#: ("S4~ .z2~.: ~~~ FAX#: (,4S) ~- (os~
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
Any correspondence, notes, memoranda, documents and materials submitted by
or concerning the Foundation for the Chapel of Sacred Mirrors and/or Alex Grey.
.- - ... .... ..
FORMAT OF RECORD (if available)
I request to be notified when I can come to iuspect the record(s) described above
o I reque"t copies of the records described above and agree to pay the cost of such records in
accordance with the fee sdlcdule OD the baclt oftbis applicaaon
o I request that the records be scot via e-mail to the address listed above
o I request that the: records be faJ[ed to the number listed above