086
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
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2009-]0-]6 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Ser. #:
0(( ~AP".
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Date Received:
DEPARTMENT:
ASSESSOR 'ftro
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 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
..!1 I ,;- I J.L
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: 3 I S- I 11-
Closed by:
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Date:
Notes:
Name:
Address: h
Amount Due: -L Pages for a total of $ D ~)"
Agency or firm:
Telephone #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF ~CORD: d
P~OIl ~ OWl
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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
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