197
Received by:
Chris Masterson 0
Christine Fulton '";"
Sue Rose tp
l/&/JL
~/'7
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: Y'
ASSESSOR
ACCOUNTING 0
CODE ENFORCEMENT 0
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 A TIORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept 7 l.;l \ / ( !
Department Head approval: - N (llr
(init)
Date Applicant cont~p:iO ~ / _
NlddttlVl ~'S3SStt
Date FOIL fulfilled or denied: :Jp N11b..L-
Closed by: IIOC (g7~ c13
Date: a31\13:Jf1~1 ~
Notes:
Name:
Address:
Amount Due: ~ Pages for a total of $ 0 _ I f'
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm.:
Telephone #: ~~)
Email address:
SPECIFIC DESCRIPTION OF RECORD:
cqo; 0;::: ~/i'IZ/J
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