201
Date Received:
Chris Masterson 0
Christine Fulton ]
Sue Rose '8;'
~/~/ 11-
JdQL
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONt Y
Received by:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0/
PLANNING ~
ZONING 0
FIRE INSPECTOR 0
HIGHWAY LJ
RECENEROFTAXES J
RECREATION 0
SUPERVISOR J
TOWN CLERK. J
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY ~
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OR DEPARTMENT USE ONLY
FOIL Ser, #:
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied:
/
/
Closed by:
~
Date:
/
/
Notes:
Amount Due:
Pages for a total of SO
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (Q-tf
Email address:
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SPECIFIC ~ES';TION OF,REC01r -(;
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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