073
Date Received:
Chris Masterson S7
Christine Fulton E.
Sue Rose 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
W~RlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN A ITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ I
Date Applicant Contacted:
(init)
/ I
Date FOIL fulfilled or denied: I I
Closed by:
Date:
I I
Notes:
Pages for a total of $
Amount Due:
Name: ~'f (,C# iP,1lt.2-
Address: . /-It /)f.j V€J
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Agency or firm: S e / J:f
Telephone #: ( ~'i61 (}!lL- 7 t.j 10 FAX #: (
Email address:
o check here if you are
requesting that the. records
be mailed to this address.
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SPECIFIC DESCR1PTION OF RECORD~~~ C0td ~J
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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