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Chris Masterson 0
Christine Fulton 0 ~S
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FOR DEPARTMENT USE ONL Y
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONL Y
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATE~SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
Date Received by Dept
Department Head approval:
/
/
(init)
Date Applicant Contacted:
/
/
Date FOIL fulfilled or denied:
/ /
---
~
Closed by:
Date:
/
/
Notes:
.oV
Amount Due:
Name: I?-z.., c...O
Address: LI f'...X2.. ST
Wa.ppJr)(reJ~ Rrlls n V / 2~-?Q
Agency or firm:
Telephone#:( )_- FAX#: ( )__
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: p
CD '-I
o F eDGeb
c;,/U~ :?t t,06~- 0.3- ItDJr;t7
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