098
2009~ 10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
EQR INTERNAL USE ONLY
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Received by;
Chris Masterson
Christine Fulton ::
Sue Rose D
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Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT 0
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECENER OF TAXES
RECREATION
SLrpERVlS0R
TOWN CLERK
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGIN'EER W
TOWN ATTORNEY :J
FOR DEP~RTMENT USE ONLY
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Date Received by Dept Lt ! i I ! i I
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Depart:rnent Head approval: .,--"
(init)
Date Applicant Contacted: !i-I Jil ...!..!-
Date FOIL fulfilled or denied: !L I J. '!.r ~
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Closed by:
Date;
Notes:
Amount Due: _ Pages for a total of $
tJ check here if you are
requesting that the records
be mailed to this address.
Name: CZ f bttrA A . G !Ai1- (f!r
Address: :; eu <;$ e t ;.. (J~~ -
LA-.) (/Lf{1 (l:J t'>.d /',,<1 (s , tV Y I Z rq ()
Agency or finn: -
Telephone#:(fll'1 )~_:'o.{i!.... F_~#:(\?i{\)kll. )'dU:r--.
Eroail address: bCK (' .'/]... ( f,' (j./'-r',1//U1, c:;!!""J
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SPECIFIC DESCRIPTION OF RECORD:
,4 I I ..f..rt:trri ~ {e -r S' f"' 'JA "". J S' u..) , 1''-' ; t1 c; U wc\ 1 f, (tpr'l d s e....uJ (> ('
01 fy.;cf"S 11'1 ;;to If) il'\clud/nt!' -+-~"fya.-vnlet^\ re ,(,'r,j.~ bt1t:1rd
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FoRMAT OF RECORD (if available)
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1 request to be notified when 1 can come to inspect the record(s) described above
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
1 request that the records be sent via e,.ma.il to the address listed above
1 request that the records be faxed to the number listed above
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