175
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
S\le Rose ~
Date Received: {p / l..-l / (I
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FOIL Ser. #:
-# /7)
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DEPARTMENT: ~
ASSESSOR LJ
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 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 JIL / .a+ / ~
, Department Head approval: ~
(init)
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied:
/
/
Closed by: ~ (l~
Date: .JL /~ / lL
Notes: J..Jut'ldl~ bp'-r
Amount Due: 3 Pages for a total of $ O. l~
Name: /}111~ t (Yt14-1l II N'
Address: '7 ~ au III Ci {)/l ,.;..e
w-~ 1/75'(:./1- k-f/ 5. ;11( (Z5"c;tJ
Agency or firm:
Telephone #: ('6 C( 5) C(r, <. - ~ 30.1 FAX #: ( ) c(~L. 02Lv
Email address:ffl4A.&..ql.fllJ.vl-(fC!J f/c14J. C'JVl
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
Co PI ~ 04.1
FORMAT OF RECORD (if available)
o 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
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