240
FOIL Ser. #:
Chris Masterson 0
Christine Fulton ]
Sue Rose 8"
12-/ Qkl 12-
c9vo
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 J
RECEIVER OF TAXES J
RECREATION 0
SUPERVISOR ]
TOWN CLERK J
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER [J
TOWN ATTORNEY J
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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: ./1.. I/}I
Closed by:
Date: / J{) e f-- IcPo/{J
Notes:
Pages for a total of $
Amount Due:
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD..,- ~ $ zfo--t ;2 CJ 1/
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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