095
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose .~
-1-1 XI JL 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #:
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DEPARTMENT: ~
ASSESSOR (2)
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENEROFTAXES 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 Applicant Contacted:
0JL1dZtj
(init)
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Date Received by Dept
Department Head approval:
Closed by:
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Date FOIL fulfilled or denied:
Date:
Notes:
Pages for a total of $ 17 S-
Amount Due:
Name: Y1 'k
Address: q< 51Y1'h CPv()j~,nr M
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Agency or firm: 11 .I
Telephone#: (jl.,( )tj~2-. - 'i11./ FAX#: (
Email address:(hSvJ)f(;..l.lK .
h jUl..J 0 check here if you are
requesting that the records
be mailed to this address.
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~gIFIC 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
.a. 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