083
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
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2009-]0-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
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FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT &.
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
VVATERJSEvrER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
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(init)
Date Applicant Contacted: ~ I Z, SI t' /
Date FOI~enied: "3-1 ~ 5:1 I /
Date Received by Dept
Department Head approval:
Closed by:
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Date:
..2-1"""51 //
Notes:
1
Name: il/""YA/., 7M>g,{~
Address: /1 ~8I2D'<'-'<
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Agency or firm:
Telephone #: ( K'Ir) ~ b (, '13 FAX #: ( ) _
Email address:
Amount Due: . Pages for a total of $
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF R,ECORD:
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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