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114
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
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j;J /1 ~
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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Date Received:
FOIL Ser. #:
FOR DEP ARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: / /
Closed by:
Date:
\1M.
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Notes:
Amount Due:
Pages for a total of $
Name: A a
Address: ? () ~ cr. 1M a / /4 S J-
~en~ocfum: !m~ ~
Telephone #: (jfll ) -iL..q " '1'7 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:
rl- m~ ~t0f
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
