127
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose 8-
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11 I~I
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Ser. #:
. ~ ~APF>
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
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SUPERVISOR '\
TOWN CLERK ~
WATER/SEWER 0
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TOWN ENGINEER 0
TOWN A TIORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted:
(init)
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Date FOIL fulfilled or denied: j, I
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Closed by: ~'.
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Notes:
Amount Due:
Pages for a total of $
Name: ~rt:-tI fJ2,IlA2..
Address: '/--It /)/-1) V€I
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Agency or firm: S e / -9'
Telephone #: ( ~'isJ a9.L- 7 '110 FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC. DESCRIPTIO. N OF RE=~. ~~[7.Mc 0-1zd ~)
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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
o I request that the records be sent via e-maiJ to the address listed above
o I request that the records be faxed to the number listed above