188
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 g....
Date Received: :l / J.a.. / -Ll.
FOIL Ser. #: J ~
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DEPARTMENT:
ASSESSOR g
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 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:
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Closed by:
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Date:
Notes:
Amount Due: -1.a- Pages for a total of $ (, S6
Name: C, t (1 '-( M t::" AN (.;t....
Address: '-" (.,v 1:,..; t2~
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Agency or firm: ~~ (!-'h.f c--
Telephone#: (;.;3 ) 14ft - {!Ij FAX#: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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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
if{ 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