255
FOIL Ser. #:
Chris Masterson 0
Christine Fulton J
Sue Rose ~
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR ~:'-
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES []
RECREATION 0
SUPERVISOR J
TOWN CLERK 0
WATE~SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY []
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Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
I I
Date Applicant Contacted:
(init)
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Date FO. IL fu1~d~
Closed tr~b '
Date: 'Yv0\ J/09i~/_
Notes:
Amount Due:
Pages for a total of $
Name: A /V/)/;"; ),//f~j)
Address: ~ ""'..It IN
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Agency or firm: 1t ~ . "v,., J I of C' c, .
Telephone #: (8f~ ~- "r~r FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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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