061
Received by:
Chris Masterson 0
Christine Fulton ~
~e Rose 0
;2/ JL-I IdO II
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Ser. #: LfJ I
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT )6
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept ..i I L ~(1D.l~.I.
Department Head approval:
Date Applicant Contacted: J 'I I.!fl ~
Dale FOIL fulfilled or denied: :5 !.@ !
Closed by:
Date: :LId! I II
Notes:
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Amount Due: .,. Pages for a total
Name: Roc;e.. Mq, (2 I e: G-e A '1
Address: Li ~ ShCl.VY\yuck: l:h /Js ?:J.,...
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Agency or firm: \ ,
Telephone#: (6Ih) 61~ - o'8"~~ FAX#: ( )__
Email address: ~ O'ie c.lZ. \ . . c. 0 i'Y\
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: '1.a:1: . l' ~
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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