092
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Chris Masterson 0
Christine Fulton D.
Sue Rose ~
Date Received: .1- / l / JL
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR 0 /'
ACCOUNTING [i6
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHNVAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Applicant Contacted:
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(init)
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Date Received by Dept
Department Head approval:
Date FOIL fulfilled or denied: '-\ / \ t\ / ~
Date:
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Closed by:
Notes:
Amount Due: ~ Pages for a total of $ ~
Name: ba (' be( ('~ Gd 2.. leT'"
Address: ~ 'KV< ~s f 1 L-tvt1-e,
I).) tIf p; n J tr.J rq lIs.. N y 1],)'1 (;
Agency or firm: -
Telephone #: ( q ILf) ~- s.{ ;;l If) FAX #: (g'4() ~- S.;( 1 ;;L-
Emai1 address:rbfz.{u@~rnt.llI
o check here if you are
requesting that the records
be mailed to this address.
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FORMAT OF RECORD (if available) ~ ~ v/;~/;/
o I request to be notified when I can come to inspect the record( s) des~bedbove
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
~ 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