132
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Chris Masterson 0
Christine Fulton 0
Sue Rose ~
Date Received: 5- / -i- / Jl.-
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR g..
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
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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FOR DEP ARTMENT USE ONLY
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(init)
DateApp~tacted: biLl c(
Date FOI fu r Cm@' 6/ L / t'(
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Closed by: <<Ii ~ ...
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Date: J Z - p S /, / c ( '/'{
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Notes:
Date Received by Dept
Department Head approval:
Amount Due:
Pages for a total of $
Name: .5'[4.s::
Address: / 7 f 9 /Z I !:? z...
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Agency or firm: ~ uf / ; h /l-n l~i/l/Y'~C e...
Telephone #: ( ) _- FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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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
I 0 I request that the records be faxed to the number listed above