130
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
~ ~AP".
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FOIL Ser. #:
DEPARTMENT:
ASSESSOR ~'
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN A TIORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
5-1 ~/-1i
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: ')/.J.1. I ..1.L
Closed by:
Date:
.5.1 .lL I D-
Notes:
Amount Due: 3-- Pages for a total of$ tJ ,/ ~
Name: S 8-(2 bt 0 L.;) Pf t--
Address: '3 '..f {Vl.p. ({.. J N "1> fL, .
j;v Prf P ~ Ny" ( "2..4'l i)
Agency or firm: _ "
Telephone#: (~~f) \lb3- \f",\(~ FAX#: ( )_-
Email address: 5 f "'1-, 0 (J. L . (" ""'"
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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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-mail to the address listed above
o I request that the records be faxed to the number listed above