004
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by; Chris Masterson 0
Christine Fulton 0
Sue Rose ~
Date Received: -1- / l!1 I -1L
FOIL Ser. #: L/
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DEPARTMENT: '\. __
ASSESSOR -a
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
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
I I
Date Applicant Contacted:
(init)
/ I
Date FOIL fulfilled or denied: I I
Closed by:
Date:
DLI/}:{I JL
Notes:
Amount Due: .ll.- Pages for a total of $ . () . 9J
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (
Email address:
\ \1
FAX #: (
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SPECIFICDESCRlPTI~~OfRD~j ~~' l"Si t\'iQ^~I.A
-;: () - co /- I A-'~(p).
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