058
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
Sue Rose or"
5l / -lL / ---LL
$$
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING ~
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENEROFTAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
o~ VJ~PI
;~' .7'~,"'~'
,0,/ " ~~~
~'~.\~\
c:.... ' f2:"
. .,A' ;' ....'
C'..;.. '. " "".
7~SS u C:;o~~ .
Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
~/I(/II
..szL -~o-
(init)
Date Applicant Contacted: J.. / /1 / ~
DateFo~ordenied:.3 //1 /1/
Closed by: /f C-
Date:
3 / II / r /
Notes:
Pages for a total of $
Amount Due:
Name: ~ '; \J'd-'" ~ "'~ \ ...,~: <'<-
Address: n~ ,Stj\ l-kl\\o""-J IlI.J
~ \..i \. N A.,....., U A \ \ l~ ""
Agency or firm: CSCi \6 SUf ui': ~\ tJt.A ~
Telephone #: ( , 3 \) q lc.. - "I '5 1 ~AX #: (
Email address: ~;;'(Ji'-.,) r....~ft...)..,...:( ~ ~&~~ ,{'.....
o check here if you are
requesting that the records
be mailed to this address.
)--
SPECIFIC DESCRIPTION OF RECORD:
StJ\\J" "'~ ~r \ 54 t~'o\~N LII\N~
~.1S'-(){- Pd3'oJ1
I
FORMAT OF RECORD (if available)
I
o 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
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