268
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Chris Masterson 0
Christine Fulton ~
Sue ~~ 0
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Received by:
Date Received:
FOIL Ser. #:
of( ~AP""
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DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECENER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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FOR DEPARTMENT USE ONLY
/ /
Date Received by Dept
Department Head approval:
(init)
/ /
Date Applicant Contacted:
---
Date FOIL fulfilled or denied:
/
/
Date:
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Closed by:
Notes:
Amount Due:
Pages for a total of $
Name: m llh ~~t7-
Address: _ _ ,_; : _ · I IV e
Agency or firm: , <; e ~
Telephone #: (fN~) 2!l:L-1l1/0 FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD:
oJ!R... (/;,J\1/')Z. ~ ~ ~~-
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