140
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
Sue Rose"Q.
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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 0
ACCOUNTING 0
CODE ENFORCEMENT '~
PLANNING Sj
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept s' / I { / ((
Department Head approval: - ~6-
(init)
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Date Applicant Contacted: --1. / :!- / _
Date F~enied: _I _I _
Closed by: l} t4 C-
Oate: tjJ / ')/~/ ~
Notes:
Amount Due: _ Pages for a total of $
Name:
Address:
Agency or firm: ~~\ ~'" '\{} fl~4
Telephone #: (l1Il{ ) ~1< -Stj2.V 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
o I request that the records be faxed to the number listed above