267
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 \I
Sue Rose Ei
Date Received: lL I~/ L1l-
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FOIL Ser. #: ~
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES :::J
RECREATION 0
SUPERVISOR ]
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
- ~(~ ~
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied:
/
/
Closed by: ~
Date: lL / d- ~ o:t) I D
Notes: ~
Name:
Address:
Amount Due:
Pages for a total of $
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (('/&~-7 ~: (
Email address: 0 '"'H' -I
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SPECIC r:lJ3:l0N 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
~ 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