138
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
S3'Rose ::J--. 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR
ACCOUNTING
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 ATIORNEY 0
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Date Received:
FOR DEPARTMENT USE ONLY
Date Receivfl Dept _ / - / -
Department approval: _
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Date Appli~on~e1rl _ / _ / _
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Date FOI~l1~r d~ed: _ /
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Closed bi!' fB
Date:
/
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Notes:
Amount Due:
Pages for a total of $ I
Name:
Address:
D~nC4V1 '
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o check here if you are
requesting that the records
be mailed to this address.
Agency or firm: 4{ ti.'j
Telephone#: (6l( ) 6/<{d-FAX#: (
Email address:
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SPECIFIC DESCRIPTION OF RECORD: ~ci ;;ilL ./J,~
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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 th~ cost of such records in
accordance with the fee schedule on the back of this application r
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