046
FOIL Ser. #:
Chris Masterson
Christine Fulton
Sue Rose
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR )(
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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Date Received:
FOR DEPARTMENT USE ONLY
Date Applicant Contacted:
2-/'J.X / JL
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(init)
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Date Received by Dept
Department Head approval:
Date FOIL fulfilled or denied: 2 / ~ / .lL-
Closed by:
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Date:
.2J:4>/LL
Notes:
Amount Due: ~ Pages for a total of $ . ~ D
Name: \\) \(.0 \ -t. Let. v-t r'---'\
Address: ~O'Ck ~~ ~ Q.:t-
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Agency or firm:
Telephone#: (<6~)~{ i - {Ol}g FAX#: ( )_-
Email address:
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)
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