184
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
Sue Rose <:!r'
Date Received: 1- / .JL I -.lL
FOIL Ser. #:
1ft 8-1
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DEPARTMENT: _/
ASSESSOR [2r
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHNVAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN A ITORNEY 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
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Closed by:
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Date:
Notes:
Amount Due: ~ Pages for a total of$ I, d. ')'
Name: -V) I I ((fkr' D u J,-~
Address: ')- 6:J J.- 0 f>---yvt h I 0 s~Cf <i
Agency or firm: ~ ~~ vll/v'" ~
Telephone #: ~ ) 61J..... - q4 7~ AX #: ( ) __
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: A ~
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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
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