180
Received by:
Chris Masterson 0
Christine Fulton ~
~e Rose 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
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FOIL Ser. #: j~ D
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DEPARTMENT:
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ASSESSOR \8-
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING D.
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 A TIORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: I I
Closed by:
bJ(ZA-
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Date:
Notes:
Amount Due: ~ Pages for a total of $ (). g;
Namt::iJift~ A /11/ Nf 7711 yO "2 ? 0 0 check here if you are
Address: L 0 tftJ~'EW E II ~ ~ requesting that the records
I'll c:.f:~ Ii S MIf S- c; 0 be mailed to this address.
Agency or firm:
Telephone#: (li'l~)~-lYI7 FAX#: ( )_-
Email address:
SPECIFIC DESCf1!IO:N OF RECORD:
()P'f~~ eA K:..n
FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record(s) described above
j! - 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