256
FOIL Ser. #:
Chris Masterson 0
Christine Fulton ]
Sue Rose y
LL / f...(L / UL.
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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 !J
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY J
RECEIVER OF TAXES J
RECREATION 0
SUPERVISOR J
TOWN CLERK J
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER [J
TOWN ATTORNEY CJ
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Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept LL / J!1 / ~I 0
Department Head approval:
(init)
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied:
/
/
Date:
~
/ /iJ/1!2/C70/0
Closed by:
Notes:
Amount Due:
Pages for a total of $
Name:
Address:
%~~~~
,
06377
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone#:(203) */- 0700 FAX#: (
Email address:
)--
SPECIFIC DESCRIPTION OF RECORD:
~ #!~~:: ~ Or
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