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146
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 )t;l
Sue Rose ' 0
Date Received: 21 LW..10X2J1
FOIL Ser. #: J '-I ~-
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
~CLERK ~
W ER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
1 1
Date Applicant Contacted:
(init)
1 1
Date:
1 1
---
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Date FOIL fulfilled or denied:
Closed by:
,/
Notes:
Amount Due:
Pages for a total of $
Name: ~~tlfA~r
Address:' J../l f) J I/~
Wlh
Agency or firm: Se 1.If'
Telephone #: ( S''i() a9.L- 7 'II () FAX #: (
Email address:
o check here if you are '
requesting tij.ilt the, records
be mailed to tlnsiddress.
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SPECIFIC DESCRIPTION OF RECORD~ ~ Urd p/t.::1..1 evrzd ~,
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~X P E IV.s E c.. 0 1/1 ~ 0 J- . /i E f 0 ~ -r 1- It R. V E' fI tA E C 0 N-rR CJ 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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