158
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
FOIL Ser. #:
DEPARTMENT: /
ASSESSOR [R'
ACCOUNTING 0
CODE ENFORCEMENT [J
PLANNING 0
ZONING LJ
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 ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
Date Applica~~_S~ _ I _ / _
Date FOI(~I~lIe~L~ied: _ / _ I _
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Closed by:
Date: ~/ d;]/ ~
Notes: kr hlU"d I~ h.fJ-
Amount Due: ~ Pages for a total of $ ". :::;0
Name: !Xtr lx'u- cL L r pc' r+-
Address: 14' ~OLue.l/ Lanl.-
, .r-:. 1 ( I" 25tA 0
waf p i~ er .s "''''1 t $" ""j "'
Agency or firm:
Telephone #: (0'1'5 ) 2cl8 - 2&$5 FAX #: ( )__
Email address: rn.t.a.5le.s' +On
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
IP~LUt>t Gl'PlJ or J.t~ti u').57-6~- ~~~f15!q
FORMAT OF RECORD (if available)
:J I request to be notified when I can come to inspect the record(s) described above
LJ 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