096
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Ro~e ..~
l/L/JL 0
1t96
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
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FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept l/. I Z ta:2J I
Department Head approval:
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: I /
Closed by:
Date:
Notes: {) DLd
Amount Due~ Pages for a total of $ ....5 ()
Name: ~\l~~~\ o check here if you are
Address: F\?--e L..L::L:lc:e:i+ ~ requesting that the records
~C~ <""I~ \ 2S~ be mailed to this address.
Agency or firm: ""2-\ ~ \ t~ ~... .t::t.-'--( ~
Telephone#: (9\,,-\)~- ~'5FAX#: (5('5) "2-~ BI8
Email address: Oc::r-<\Pbelt , ~e( Lt....{ e- ~~n~, ~ .
SPECIFIC DESCRIPTIqN OF ~CORD: . .
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FORMAT OF RECORD (if available)
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I request to be notified when I 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
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above