181
Received by:
Chris Masterson 0
Christine Fulton '16
Sue Rose 0
I ILl-ILL
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{JJ 2009-] 0-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR )S.
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
Date Received by Dept I /
Department Head approval:
Closed by:
Date:
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Notes:
Pages for a total of $
Amount Due:
~ (" J / /
Name: .. C't:>r~ ~]//(
Address: ~3 ~I[id" ~rct
_ ,r,"P1""f~4_-l(j _ N _ _ rj?Z:-
Agency or firm: t/' /
. Telephone#: ('117 )~- 2/36 FAX#: ( )__
Email address:
o check here if you are
requesting that the records
be mailed to this address.
I
SPECIFIC DE$CRIPTION OF RECORD: .....1-
fJ[ Z'd f:v"-. 7.fJrUr./' C Ar/ .
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