094
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FOR INTERNAL USE ONLY
I
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
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Received by:
Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 'g'
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W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: vn- / -
Closed by: A
Date: /.!L / R /-1L
Notes:
Pages for a total of $
Amount Due:
Name: f-?\-\1Yio" 1~1unK- 0 check here if you are
Address: ~ l~l~~\J1 \ \-e_ n~~~ ' requesting that the records
0- 'I '9-'5 ktu8~ lIe "-( 1'255 7 be mailed to this address.
Agency or firm: ttu~()J\\\(' pO
Telephone #: (.~LfS )> n - 11 tC(4 FAX #: $L(S) &41 - y'5(:;,O
Ernail address: . S SCe--re @ c ~w .rE'--\-
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
o I request to be notified when I can corne 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