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204 FOIL Ser. #: Chris Masterson 0 Christine Fulton "I ~ Rose 0 ---L / ~(/ lL (~L/ I 2009-10-16 JCM TOWN OF WAPPINGER Application for Public Access to Records FOIL REQUEST FOR INTERNAL USE ONLY Received by: DEPARTMENT: ASSESSOR 0 ACCOUNTING 0 CODE ENFORCEMENT 0 PLANNING 0 ZONING 0 FIRE INSPECTOR 0 HIGHWAY 0 RECENER OF TAXES Q RECREATION 0 SUPERVISOR J TOWN CLERK J W A TERlSEWER 0 DOG CONTROL OFFICER 0 TOWN ENGINEER 0 TOWN A TIORNEY [] Date Received: FOR DEPARTMENT USE ONLY Date Received by Dept Department Head approval: ~/;l7111 ~ (init) Date Applicant Contacted: ::l 1 :211 .!.!- DateF~denied: 7/ z7; II Closed by: 1ft 0- Date: .2127/_ I~ It.~ ,~S- =- i_100 Notes: Pages for a total of $ Amount Due: Name: LED<I\J~~ ~6t..I0,J 0 check here if you are Address: Z(p(p I:"t-v'J VI 1(("' ~b requesting that the records &0,1 bl+lC.~..J,,'ir I ;-/-1~ 12.& D..3 be mailed to this address. Agency or firm: r;zrcJ<:;'t:1 G'zJL~t.;hVc\l [), ~"!\.'\-j'1lte..J {!.cr- Telephone #: (81-IS)~- ~8'?? FAX #: ( ~) L.We-- 'f ;-..ry Email address: LFNA/elJo~ C? tJf>'itJN{(I-ve... < v~ SPECIFIC DESCRIPTION OF RECORD: ~ +=0 p~c..r ~ T4.Jt- 012 22., J?v:f L 0.'2 ..: J Ie t2D I I/J.,q.;JPA.i(O~ A4t:lJ I /lJ 7 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