104
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ?
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310i
2009-]0-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
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Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTmG ~~/
CODE ENFORCEMENT ~
PLANNmG 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 ENGmEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
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(init)
Date Applicantgontacted: Q{ 1 /? 1 ~
DateF08denied:ocfl(J ILL
Closed by: pL( 6-
Date: 0/ II}/~
Notes: Cf!~--
Date Received by Dept
Department Head approval:
Amount Due:
Pages for a total of $
Name: ~R(c /f l?tocr'l-)
Address: 1 } I r IYJ /} X "'-11'\''1
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o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (1/1 )!Lz!L- {,,17,/ FAX #: (
Email address: Cb!.:Ji),-. q:>Z'If cr:t I. o.f,....,&/ f /, ~ "'"
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SPECIFIC DESCRIPTION OF RECORD:
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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