159
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 0
Sue Rose ~
Date Received: ~ / a, / -1L
FOIL Ser. #:
-=It /67
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
VVATER/SEvv.ER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
I I
Date Applicant Contacted:
(init)
/ I
Date FOIL fulfilled or denied:
Closed by:
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Date:
/
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Notes:
Amount Due:
Pages for a total of.$
Name:
Address:
3~f!ff8~7~tQ~y
o check here if you are
requesting that the records
/ (Y.) ;;'0 be mailed to this address.
Agency or firm:
Telephone #: (!?'-f ))rJrr- ? Y / ()
Email address:
FAX #: (
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SPECIFIC DESCRIPTION OF RECORD:
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