266
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 2'
Sue Ro).e 0
lL I t:L I{ J..L
~(OLf)
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
Date Received:
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY []
RECEIVER OF TAXES []
RECREATION 0
SUPERVISOR J
TOWN CLERK ~/
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY []
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: ~ I \ ~ / ~
Closed by:
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Date:
Notes:
Amount Due: au.- Pages for a total of $ s.. 0!
Name: 5 (/),.1/1/ /~
Address: 2- 0 ~v ' .A/
w;:=+ 12,-90
Agency or firm: ,
Telephone #: ( 9/II}!f.L6. 9 6 ~I FAX #: ( ) _-
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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