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259
FOIL Ser. #:
Chris Masterson 0
Christine Fulton ~J
Sue Rose
lLI al.l!L
f)69
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL RE~UESTC
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FOR INTERNAL USE ONLY
Received by:
Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING . 0
CODE ENFORCEMENT ~
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 'J
TOWN CLERK []
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY CJ
Date Received by Dept
Department Head approval:
FOR DEPARTMENT USE ONLY
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Date Applicant Contacted: 11 I I SI i!-
DateFO~enied: JLJ rS7LO
Closed by: f1 (r
Date:
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Notes:
Amount Due:
Pages for a total of $
Name~ \-\ n fq k~
Address: ~ Ct oS br)r/lC"" H; Il ~
t-VCl.e<~ 1\,5" r \' fCl II < I Vi
Agency or firm:
Telephone #: ( /'sI-(\ ) 5.)1... - ('rl"J1. ~ FAX #: (
Email. address:
o check here if you are
requesting that the records
I'J_ no be mailed to this address.
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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
