052
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose d-EJ
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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:
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ACCOUNTING 0
CODE ENFORCEMENT ~ - #0 /
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENEROFTAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: '?,/ / ~ / ~
Closed by:
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Date:
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Notes:
Amount Due: ...B:-- Pages for a total of $ ~ V
Name: J~JJ/{*,- milS h..y
Address: j~" l~J,+ ,.1IId J.J-~ ~ V",,-I t
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Agency or firm: liI'l "J e..) ~ 1\ ~
Telephone #: (1/" ) 11.1,-.-/4 n FAX #: (,.., ).JuL- /1.1 t"1i
Email address: . of If c.4 . tI ,. ...,
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)
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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
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above
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