200
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
L/ !l.b./JL. 0
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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:
, ~ VJAPp
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FOIL Ser. #:
DEPARTMENT: /'
ASSESSOR W
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER 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
Department Head approval:
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-L -fJ'fltI'r
(init)
/ /
Date Applicant Contacted:
Date FOIL fulfilled or denied: / /
Closed by:
tV (21T
1/2&2/11
Date:
Notes:
Amount Due: "3 Pages for a total of $ (). / $"
Name: c.S h c< W'VI. P e...~h1 0
Address: ~ 1 S co ++ ,( .
(" lAP? :C/1./6Er25> ~I'9LL5
Agency or firm:
Telephone #: (81./f ):J1'7 - 151;; FAX #: (
Email address:
o check here if you are
requesting that the records
~v. ):2.570 be mailed to this address.
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SPECIFIC DESCRIPTI~ OF RECORD:
beed t> r Cf bUJ I!.
4 JdtesS
FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record(s) described above
\0"' 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
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