192
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 ~
Date Received: l/ ~/1L-
FOIL Ser. #: '1/1'1 a...,
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT IZJ/
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept '7- / ~
Department Head approval: ~
Date Applic cted: 1 Jr! / 1
denied: 1 / II
Closed by:
Date:
Notes:
Amount Due:
Pages for a total of $
Name:
Address: h cI J//./'oQ Pv'
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Agency or firm: p nA d.P l1. -{1 tel ~ tI ( fr t IY\J f/r vi'
Telephone#: <1N )!:iIL- JIJL< FAX#: ( )_-
Email address: 'C. ~ A.o ' ,S::e/\ (
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: 4
gO a I f ~tJ) 1-1// / f(
FORMAT OF RECORD (if available)
[!(' 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