003
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose .~
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Date Received:
FOIL Ser. #: --'-3
DEPARTMENT:
ASSESSOR 0
ACCOUNTING -&
CODE ENFORCEMENT ~
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
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FOR DEP ARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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DateApplicant Contacted:
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Notes:
Amount Due: _ Pages for a total of $
c'D c. D PW) 0 check here if you are
'>, .- /' requesting that the records
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Name: g.C) G A I c... ~s
Address: c;, 2. ~ D.M.. 6 "5> 5'
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Agency or firm: G t-J"G. DC D P W
Telephone #: (<345 ) .tj-ct,c;,.. '2."1 ztlJ FAX #: (<645) 4e~. ., -z.q 4-D --c:!.9:--
Email address: C/o .s~ ~- 8'1'S"-4gG -,2, 7.:l?
SPECIFIC DESCRIPTION OF RECORD: ;l % -DC)~
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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