116
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
:L/rli/ .J.L
-11/1 (P
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
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FOIL Ser. #:
DEPARTMENT: -X
ASSESSOR C)
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept -4=- / ~/ 11-
Department Head approval: Al.Jl.iT
(init)
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied: c.( / ~ / ~
Closed by:
fJfl.Ir-
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Date:
Notes:
Amount Due: -8... Pages for a total of $ O. 7S-
Name:J a.vl ~ C. Gr LS. 0
Address: 33 .s -r- )II cJ10 ia..r R4
UJ. I~
Agency or firm:
Tel~hone#:(gi.s) G.3~-..9tfp ~AX#: ( )__
Emad address: r~k t:> h II t.A.VtO. co",
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
l;) e. €' d ~ (" ~ l.' v.e h c (,.l..! e..
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