191
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Received by:
Chris Masterson 0
Christine Fulton ~
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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. #:
DEPARTMENT:
ASSESSOR ~
ACCOUNTmG 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE mSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGmEER 0
TOWN A ITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
7 /j{/ II
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(init)
Date Applicant Contacted: _ / _ / _
Date FOIL fulfilled or denied: 7 / / {" / L
Closed by:
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7 / /S/lL
Date:
Name: .:
Address: ! C .
a/a I)I?I~ -tYc..
Agency or firm: {I
Telephone #: ( ) _-
Email address:
Notes:
Amount Due: !:I- Pages for a total of $ J.P 0
o check here if you are
'f , requesting that the records
I ') S '1.... 0 be mailed to this address.
FAX #: ( ) -
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
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