070
Received by:
Chris Masterson 0
Christine Fulton jf
Sue ROS~ 0
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2009-10-16 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
ACCOUNTmG 0
CODE ENFORCEMENT 0
PLANNING 0
ZONmG 0
FIRE INSPECTOR 0
HIG~AY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER "p
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
Date Applicant Contacted: _ I _ I _
Date FOIL fulfilled or denied: !2 I 41 J.L
Closed by:
Date:
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Notes:
Name:
Address:
Amount Due:
Pages for a total of $
Agency or firm: k-e l.V CJVJI1~
Telephone #: ( Cl.t5)!2IL- ?-lli FAX #: ((Ce!) tJ-ps: ~(3
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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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