173
FOR INTERNAL USE ONLY
Received by: Chris Masterson 0
Christine Fulton %'
Sue Rose 0
Date Received: U. / Q:] / ..!..!..-
FOIL Ser. #:
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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
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted:
Date FOIL fulfilled or denied: / /
Closed by:
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Date:
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Amount Due: -1:L Pages for a total of $ I, 0 ()
Name: 0 check here if you are
Address: requesting that the records
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Agency or firm: '3 (be) ~ L L-- c-
Telephone #: (~:.s-) ~3~- J- 26.s- FAX #: (N ) &~;2..- J- 'ic9 ~
Email address:
SPECIFIC DESCRIPTION OF RECORD:
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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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