020
Date Received:
Chris Masterson 0
Christine Fulton /.1
Sue Rose C)
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11"&0
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
ZONmNG 0
FIRE INSPECTOR U
HIGHWAY []
RECEIVER OF TAXES 0
RECREATION LJ
SUPERVISOR 0
TOWN CLERK 0
W ATERlSEWER n
[)()G CONTROL OFFTCER [1
TOWN ENGINEER []
TOWN ATIORNEY 0
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FOIL Ser. #:
FOR DEPARTMENT USE ONl., Y
Date Received by Dept ~ / 3:.. / ..LL
Department Head approval: Ali2.lr
(init)
Date Applicant Contacted: _I _I _
Date FOIL fulfilled or denied: ~ / ~ IlL.
Closed by: fJ rzA--
Date: ~/~/~
Notes: ~ it> a.pp} ,'u-t<5t
Amount Due: -- Pages for a total of$ -
Name: fLm aM fL P ~ relb U check here jf you are
Add...OOI t'R/)~~4i'..P.~~~ ro<iuoatinf5 i:hat tho.--<>nJ..
15/)/ A(oaduJQ...Y tvtuJ yor (.. I0Y be mailed to this address.
Agency or firm: Hen f.!!!i!=..J:.e()..-lfY r5rov.-P
Telephone#:( q/~ )~-fgi9&-' FAX#: (flit{ )~- NOj
Emailaddress:tmanmail.com
SPECIFIC DESCRIPTION OF RECORD:
a.- e/JPV tJF propl.(fy card.- For 151./ ~()b(nSon Ia.JI.I_
FORMAT OF RECORD (if available)
o J request to be notified wben 1 can come to inspect the mcord(s) described above .
1.1 I request copies oftbe records described above and agree to pay the cost of such records In
accordance with the fee schedule on the back of this application
if1:- I request that the records be sent via e-mail to the address listed above
~ 1 request that the records be faxed to the number listed above
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