085
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
F f/L REQUEST
FOR INTERNAL USE ONLY
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose g-
3-/&1 -1L
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Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 'l
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
VVATER/SEvv.ER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
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denied: 3. /111 ~
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Date Received by Dept
Department Head approval:
Date:
Notes:
Amount Due:
Pages for a total of $
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Name: ~.~U. U 'ShL1ua
Address: 11~ IS ELL 1~\lG w \1.(J
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Agency or firm: OS CJ \() cs.u ( U I""--l i tJC.t
Telephone#:(G,3{) 9!-<. - 4:5 3 i'AX#: (~'3' )5/1 - C;LoI
Email address:~I~l.J-.l-.l r'o"\ ~ h r', \J ~ I( e.... ~ ~ ~
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPJJON OF RECORD'
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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
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