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Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR INTERNAL USE ONLY
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
S ERVISOR 0
OWN CLERK ,,~
WATE SEWER ~
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
(init)
Date Applicant Contacted: _ / _ / _
Date FOIL fulfilled or denied: ~i~ I / /
Closed by: J '
Date:
/ /
Notes:
Name: -r </ (Z
Address: ~ .
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Agency or firm:
Telephone #: ( ~)5.q 0 - J fY , FAX #: (
Email address:.:) -r G\ \ 0/ ~ ?j,-ri)~ 17 /..c" ~
Amount Due:
Pages for a total of $
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)
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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
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the nmnber listed above
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