103
Received by;
Chris Masterson 0
Christine Fulton 0
s{e Rose '~
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received;
0(( ~AP1>
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FOIL Ser. #:
DEPARTMENT: \/'
ASSESSOR 61
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK. 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept !/.. / E ClV'1 (
Department Head approval:
(init)
Date Applicant Contacted: d-( (<0 dJ I (
Date FOIL fulfilled or denied; / /
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Closed by:
W/8
Date:
/
/
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Notes:
Amount Due: ~ Pages for a total of$ ;- ~
Name: It.) d. e '^' g c)( 0,'"1 J
Address; 2 2. ~e ('te\ 7? ~..---
tNOtpri"'7r'-f r::al(~ 1v'1/257c)
Agency or firm:
Telephone #: (,< '1";) ~ 9& _ ob3 5 FAX #: ( )__
Email address:St.nr-cLl!...72@)Qc(.cc/.........
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
C .::> {' -I L ~ de '
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