145
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 It;l
Sue Rose ' 0
Date Received: .5.. / LiL / c3i2k
FOIL Ser. #: I LJ 5
DEPARTMENT:
ASS 0
ACCOUNT
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: / /
Closed by:
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Date:
.!i I/JSl_ / 1.L
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Notes:
Amount Due:
Pages for a total of $
Name: ~~fJ2,~1f'
Address: ' l f) J t/€J
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Agency or firm: S e / .I?-
Telephone #: ( ~"I() a:J.L- 7'1 I () FAX #: (
Email address:
o check here if you are
requesting tlikt the, records
be mailed toiliis'iddress.
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SPECIFIC DESCRIPTION OF RECORDa<<. !., ~ (?~ ~ ~,
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~X P E IV SEe 0 11/1 ~ 0 t- . ri E f 0 ~ l' r R R V E" fI t< E C 0 NrA 0 L
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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
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