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FOR INTERNAL USE ONLY
Received by:
Chris Masterson 0
Christine Fulton .~
Sue Rose 0
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10
Date Received:
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR DEPARTMENT USE ONLY
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Date Received by Dept
Department Head approval:
Date Applicant Contacted:
(init)
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---
Date FOIL fulfilled or denied: .L gO~1 (
Closed by: H-6
Date:
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Notes:
Amount Due:
Pa
Name: 'J:'IitY .r;L 0-, [oLjJG:-
Address: 43'r s.C>.I'-'~ P\~c".s ~\""\J
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o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone#: (qD0 )').1)) -blfCj, FAX#: (
Email address: l::>'J7-.dt/8~ @ A-oi - c:.....,.....
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SPECIFIC DES.QUPTIO~..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
