047
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose Q/
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:#37
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #:
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DEPARTMENT:
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ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 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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Date Applicant Contacted:
Date FOIL fulfilled or denied: ~ / l / ~
Closed by:
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Date:
Notes:
Amount Due: --L Pages for a total of $ n . ~ r-
Name: 5.... \,.) J "'-c... ~ I<'"\,. v'l V-.?
Address: "G "1? ~~ So T
Agency or firm: C1 1'-t. fJ c....- ~
Telephone#: (~ur).st.!' _l '21) FAX#: (
Email address: (N. ~b c::....", ~ \.. ~Cc:A..-.
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFICJ)c1SCAIPTIhON OF RECORD: p-o /J ;-<./1 /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
<f" 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