125
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Chris Masterson D
Christine Fulton LJ
Sue Rose ~
Date Received: 6- / l / J..L
FOIL Ser. #: -rt /dt'5
DEPARTMENT:
ASSESSOR
ACCOUNTING 0
CODE ENFORCEMENT LJ
PLANNING IJ
ZONING IJ
FIRE INSPECTOR IJ
HIGHWAY 0
RECEIVER OF TAXES []
RECREATION []
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER [J
DOG CONTROL OFFICER IJ
TOWN ENGINEER IJ
TOWN ATTORNEY 0
I
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
(init)
Date Applicant Contacted: _ / ~~
~~
Date FOIL ~lfiIled or denied: _ / _ %.~
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Date: ~:3 ~v:-~ \'Gi
Notes: ~ ~ ~
Pages for a total of $
Amount Due:
/' Name:
Address:
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Agency or firm:
Telephone#:(8"ts'") /P/'1'- q05"1 FAX#: ( )__
Email address:.4vonb~I~@Jtt-.?lln.net
n check here if you are
requesting that the records
(v'-{ IZS-'7v be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
CCC! lOr J",d
..5- ;)EN /1//:S 12 tf.
FORMAT OF RECORD (if available)
u I request to be notified when I can come to inspect the record(s) described above
J 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
n I request that the records be faxed to the number listed above