182
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 )g
Sue Rose 0
Date Received: -=r / ( / i.L
FOIL Ser. #: If 2-
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DEPARTMENT:
ASSESSOR 0"
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING D
FIRE INSPECTOR D
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION D
SUPERVISOR 0
TOWN CLERK D
VVATER/SEVVER 0
DOG CONTROL OFFICER D
TOWN ENGINEER 0
TOWN A ITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
-.l / -=r / --.!.l
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied:
/
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Closed by:
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Date:
Notes:
Amount Due: --t- Pages for a total ~f$ :1r 00
Name: ~l~ t4Y\.. ~
Address: ~ ~ke O"qze!. b-
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Agency or firm:
Telephone #: (Z-t z- ) 2L- 5 ~<::;;L- FAX #: ( ) -
Email address:
o check here if you are
requesting that the records
be mailed to this 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
$- 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