254
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 ]
Sue Rose 0
Date Received: JJ/- / -I/fl ~()
FOIL Ser. #: c56 G(
DEPARTMENT: " /'
ASSESSOR ~
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHNVAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR LJ
TOWN CLERK. 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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FOR DEP ARTMENT USE ONLY
Date Received by Dept J!.... / @CJ() (
Department Head approval:
(init)
Date Applicant Contacted: _ / _ / _
Date FOIL fulfilled or denied: !.L c/lt~./ ()
Closed by: ~
Date: (L1(/i/datO
Notes:
Amount Due:
ges for a total of $
Name: ~ tL~jC,e-f' 0 check here if you are
Address: / <-I '3 fYJ Fr I;-J requesting that the records
C 0 L f) S:.r/' A;./1 -,h _ JY be mailed to this address.
Agency or finn: (( '.2-~ p ,,- -r- ~ M '-G... ~ ~ 'h __
Telephone #: (ay;1 ;;z. ~ b -'1)/ ;3F AX #: ( ;J ) ~ S- -'< (.. ~ .::2-43'7
Email address: c _ ~ C jC.- K ~ "e e
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