202
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 ~
Sue Rose 0
Date Received: { /;)7 / ~
FOIL Ser. #: (;20~
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 'R
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHNVAY 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
Department Head approval:
/ /
(init)
/
/
Date Applicant Contacted: _I // _
Dale FOIL fulfilled or denied: ~ / _
Closed by: /
Date: .,/" _I _/ _
Notes: I'
Name: t.c
Address: /9' Y9 H'(frqW :?
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Agency or firm: ;r u {; h 'f1? L--+vvr..en ce-
Telephone #: (y y 5 ) IT!L- 3 1'~ ~ FAX #: ( ) _-
Email address:
Amount Due: Pages for a total of $
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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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