179
FOR INTERNAL USE ONLY
Received by; Chris Masterson 0
Christine Fulton ~
Sue Rose 0
Date Received: L1..- /3Q / ~
FOIL Ser. #: ) (0
DEPARTMENT: ~
ASSESSOR
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 ATTORNEY 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
"C( WAP~
..:.. '" _-,..,. '1A.
~.~" ,'.,,'Fl;!
;'0/ ' '-:;;:,~'.
.... ,~,
;'0\ . .\~
...~..~./';t.'
(I. ,./~:!
" :1..".1>- . .._ >' ..:;..4..
7"55 -c()~~ .
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
iL / !f7o / .J...L
~n-
(init)
/ /
Date Applicant Contacted:
Date FOIL fulfilled or denied:
/
/
Closed by:
;JIM-
~/3D/JL
Date:
Notes:
Amount Due: J2L Pages for a total of$ SrOO
Name: CL~^, ::z;oc..leJC....~
Address: 10 o+t...~:r i!f!'o~
w~~6feS~ ~tt.;. N.~ /JZf'tJ
Agency or firm: -
Telephone #: ( ?It.! ) ~~L- 7777 FAX #: ( ) __
Email address:~JIi)C..<2GntAd..c.cn--. .
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
C ~<)e.-Ol-5,!07Zf)
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