119 (2)
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
-.i. / c2!l1 J.L
11//9
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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FOIL Ser. #:
FOR DEPARTMENT USE ONLY
Date Applicant Contacted:
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(init)
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Date Received by Dept
Department Head approval:
Date FOIL fulfilled or denied: 5 1 l. 1 \ I
---
Closed by:
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Date:
Notes:
Amount Due: ~ ~ Pages for a total of$
Name: t1J I j.,,/, / A M. :r F'u k TcvV
Address: Ie ff1{J../c::. Sl,Qe.QT
oJA1'PlwGe~ F'~"'h.s 1lJ~. /d~CJ
Agency or firm:
Telephone#: (81{S-)~-~/03 FAX#: ( )_-
Email address: xeLo,(~:J.. (Ji> m;StV # C()IV\.
o check here if you are
requesting that the records
be mailed to this address.
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