134
FOR INTERNAL USE ONLY
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Chris Masterson
Christine Fulton 0
Sue Rose 0
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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 0 FOR DEPARTMENT USE ONLY
ACCOUNTING 0 TI!LIL
CODE ENFORCEMENT ~ Date Received by Dept
PLANNING 0 Department Head approval:
ZONING 0 (init)
FIRE INSPECTOR 0 Date Applicant Contacted: / I
HIGHWAY 0 ---
RECEIVER OF TAXES 0 Date FOIL fulfilled or denied: .,:)1 Ilf
RECREATION 0
SUPERVISOR 0 Closed by:
TOWN CLERK 0
WATER/SEWER 0 Date:
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DOG CONTROL OFFICER 0 Notes:
TOWN ENGINEER 0
TOWN ATTORNEY 0 Amount Due: Pages for a total of $
Name: ~~\c.. c.. ~""~INI~
Address: 5 J:Q.U~JCI"C'S lUJA1)
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Agency or firm:
Telephone #: (qt'-l ) ~- 2.'{~4 FAX #: (
Email address: C \t'.I\~ b 1 ~ ''f ~hov. (CJVl
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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
~ 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