050
FOIL Ser. #:
Chris Masterson 0
Christine Fulton ~
Sue RO~ 0
2.1 / -1.L
5)
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0
~CO~ING'~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNEY 0
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Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
--
Date Applicant Contacted:
(init)
/ /
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Date FOIL fulfilled or denied:
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/
/
Closed by:
Date:
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/ /
Notes:
Amount Due: Pages for a total of $
Name: ~ &:-71 /JJIl/..;Z..
Address: ;...It f) fI J ve"
tJ I ):::1
Agency or firm: Se I R
Telephone #: ( re'15J'd!n.-- 7 'II 0 FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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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