207
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
Sue Rose '8-'
LI 0-1 cf/:QLo
:rtdO 7
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN A TIORNEY 0
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Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted:
(init)
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Date FOIL fulfilled or denied: I I
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Closed by:
Date:
Notes:
Pages for a total of $
Amount Due:
Name: i::. :;;{: -J:::', ''t'- 0 ~ 0 check here if you are
Address: Z 0 ~ / C! /I,A I ~ requesting that the records
tyk /J n 1"#1,c;..c { 5 1-4 {] - 50 tV 'I I Z f';9' .,::;be mailed to this address.
Agency or firm: ' I I' '
Tel~hone #: ( 6)'1.0 2:::iJj - 95)f?fFAX #: (
Emall address: ~- e I;, w n /
SPECIFIC DESCRIPTION OF RECORD:
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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