055
Received by;
Chris Masterson 0
Christine Fulton ]
Sue Rose g-
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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:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT gr"
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY u
RECEIVER OF TAXES J
RECREATION 0
SUPERVISOR 0
TOWN CLERK u
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept -3- 1 fil'
Department Head approval: .
. ')
Date Applicant Contacted: 21 K 1 JJ
Date FOIL fulfilled or denied: '3 1 ..:i 1 J!L
Closed by: @
Date: .5IJi 1 11
Notes:
Amount Due:
Pages for a total of $
Name: S-r"l-~ IJHcJrJ h (\J PPc'k
Address: ? fa M (i<.-"H" L t''1 S ')
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6lA.~p'eK . 0 check here if you are
me \(\()l~,~ ':>\ requesting that the records
, be mailed to this address.
Agency or firm: "
Telephone #: (9/ '-() lIL- f 51 cj FAX #: (
Bmail address:
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SPECIFIC DESCRIPTION OF RECORD:
<) u fLNY'1 I A N~( V "1-0 LA\-w.Jr-l ) 1
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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