218
FOR INTERNAL USE ONLY
Received by:
Chris Masterson 0
Christine Fulton 0
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Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ~. - () I ~
ACCOUNTING 0
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PLANNING 0
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FIRE INSPECTOR 0
HIG~AY 0
RECEIVEROFTAXES ~c:9dO
RECREATION 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted:
Date FOIL fulfilled or denied: lb- / ~ / JiL
Closed by:
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Date:
Notes:
Amount Due: 5- Pages for a total of $ ~. 00
Name: 6...1 ({ Y ~ VI/<. CN / ~
Address: /3 YA /'Pp,8/f-vY I'''S,/ o.
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Agency or firm: C ~ ~ID tv.4" ~ l.. /$/1 A/ ~ r,n...
Telephone #: ( ?/n/.'19 - 9tJYt5 FAX #: ( )_-
Emailaddress: 6"'~Y.S (/A(,HII<~ (;,~/yal/~.s "efJH
o check here if you are
requesting that the records
be mailed to this address.
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
~ 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