110
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
1-/ flil/ QQiI
# j ~(J
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING [}/' / I 0
CODE ENFORCEMENT 0
pLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
W ATERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
~ 'ldAPp
. -"'-.~' '.'___".''''. 'lA,
~"" ,,' ' . ':.."
o / . : .~.:\.~
"i- ,,' '.'
,: . '
'O.,.~.'~
c....<< }~'
;,' ).lo."
C" ."
.~~. ."..' -<\.~
5S cO'"
Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: / /
Closed by:
Date:
---
/ /
Notes:
Pages for a total of $
Amount Due:
Name: ~ Gel! fJ2.1lt.A
Address: f.{t f) It J v~
tJ,PI
Agency or firm: Se J.If
Telephone #: ( ~Lj() CiB.L- 74'10 FAX #: (
Email address:
o check here if you are
requesting that the, records
be mailed to this address.
)--
SPECIFIC DESCRIPTION OF RECORDO~ Urd p/l,4/ ~ ~,
/1At4) ClYVJ~/~~ d ~ /
EXP E NS E (,ol'/j ~OL' /1 EfO~1" r f~ ~v Ef/ IAE C ONjRoL
po T
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