121
FOR INTERNAL USE ONLY
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Chris Masterson
Christine Fulton 0
s~e Rose 0
14/11-
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by:
Date Received:
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FOIL Ser. #:
DEPARTMENT: _~
ASSESSOR V
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
VVATER/SEvv.ER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ 1
(init)
Date Applicant Contacted: ~ 1 _
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Date FOIL fulfilled .s2~~~ed:~ 1 ~d
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Date:
Notes:
Amount Due:
Pages for a total of $ .0
Name:
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o check here if you are
requesting that the records
be mailed to this address.
FAX #: (
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SPECIFIC DESCRIPTION OF RECORD:
(/p// u/ Pb~P of MY r[~ry
FORMAT OF RECORD (if available)
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I request to be notified when I can come to inspect the record(s) described above
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
I request that the records be faxed to the number listed above
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