205
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Chris Masterson 0
Christine Fulton 0
Sue Rose ~
Date Received: 3- / lJl / .L!2
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK [j../
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEP ARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: > -.)) I
Closed by: , /
./
Date: L/ )0 / ~
Notes:
Pages for a total of $
Amount Due:
Name:~~ t7!I~~Z- o check here if you are
Address: _ W'~' -? 'k_ i 1/ e; requelrting that .the records
. eh. Yla....'l9(J be maIled to this address.
Agency or firm: S' <2... 08 -
Telephone #: (?J5) ~- '7 LJ /0 FAX #: (, ) _-
Email address: a e I I Cl ~
SPECIFIC DESCRIrTION OF RACORD: I
f7 hI.. U ou~11 ehS t.J Iii? B f / IS 0,)1 d lj) hit e.t)f() hd e.M (!.. e Lg;s
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