235
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 J
Sue Rose tr
Date Received: /0 /2L/~
FOIL Ser. #: B3:5
DEPARTMENT:
ASSESSOR 0 FOR DEP ARTMENT USE ONLY
ACCOUNTING 0
CODE ENFORCEMENT 0 Date Received by Dept I I
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PLANNING 0 Department Head approval:
ZONING 0 (init)
FIRE INSPECTOR 0 Date Applicant Contacted:
HIGHWAY 0 I I
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RECEIVER OF TAXES 0 Date FOIL fulfilled or denied: I I
RECREATION 0 --
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SUPERVISOR ;r Closed by:
TOWN CLERK
W A TERlSEWER 0 Date: Ul)&/~
DOG CONTROL OFFICER 0 Notes:
TOWN ENGINEER 0
TOWN ATIORNEY 0 Amount Due:
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Name:
Address:
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requesting that the records
be mailed to this address.
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Agency or firm:
Telephone #: ( '&f/J m-- 7"'1 b FAX #: (
Email address:
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SPECIFIC DESCRIPTION OF RECORD: 'L~~C;r;;
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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