212
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
2-/ ~'1/~
d1f) .J.C1/3
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 ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept q [)(s;/ (0 '
Department Head approval:
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: / /
Closed by:
Date:
/ /
Notes:
Amount Due:
Pages for a total of $
Agency or firm:
Telephone #: ( ~'1o) a;:u....~7J{j FAX #: ( )_-
Email address: Bell HI F (€. arh1IJ/Iv / UJ ~
o check here if you are
requesting that the records
~ t"- 3 ~be mailed to this address.
SPECIFIC DESCRIPT~9N OF RECORD: d.
ft!-..J--lJoucttERS ''tVlcl C!.-.O}1hespo J1 eUr!.-G "'-OJ
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