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Date Received:
Chris Masterson 0
Christine Fulton )d
Sue Rose 0
S-/f 61 JL
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #:
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CODE ENFORCEMENT 0
PLANNING 0
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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 A TIORNEY 0
FOR DEPARTMENT USE ONLY
Date Applicant Contacted:
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1 1
Date Received by Dept
Department Head approval:
Date FOIL fulfilled or denied: 1 1
Closed by:
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Notes:
Amount Due: ~ Pages for a total of$~
Name: ff .4-,,::> bU.J?ttJ-<ji'~
Address: ~. ~~ I
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Agency or firm: S fLF-
Telephone #: (<245) '2 (l.J - 0)50 FAX #: ( ~l./5 L_~.L- 0700
Email address:
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requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: n
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FORMAT OF RECORD (if available)
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I request to be notified when I can come to inspect the record(s) described above
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
I request that the records be faxed to the number listed above
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