109
FOR INTERNAL USE ONLY
Chris Masterson 0
Christine Fulton 0
Sue Rose "Q"
~/ !lD./ .&QiIC)
#/6 1
Received by:
Date Received:
FOIL Ser. #:
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
. ~ ~AP~
-"".. ~rc-. ...'.... "+, .
,~/. . .~...~.
o / ' :.- :\,~.,)
11-/ "
'o'\5f~')>'i
c::. . / Z'
,A' /J.."
C' .,' ,~'
.~. ,~''''-^' .<~
. "'55 cO""""
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
o
~
o
o
o
o
o
o
o
~/O~
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ I
(init)
/ I
Date Applicant Contacted:
---
Date FOIL fulfilled or denied: / /
Closed by:
Date:
I I
---
Notes:
Amount Due:
Pages for a total of $
Name: ~ CCtl 'fJ2.1lt.z..
Address: J-.I( t)fd ve,
WIP,
Agency or firm: S e I R
Telephone #: ( ~'i() (iBL- 7 '110 FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
)--
SPECIFIC DESCRIPTION OF RECORD~ ~ 1/r-.te.A C'A<V 0Azd ~,
/PAf~)Co--'vf~ry1~~
~XP E Jv'S E COA/, ~ oJ- fi EfO~ -r r IY ~V E"fI lAE C ONrAoL
o 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