208
Date Received:
Chris Masterson
Christine Fulton
S1,:lf Rose
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #:
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DEPARTMENT:
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 ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept .ss:- / ..d / -1.L-
Department Head approval:
(init)
Date Applicant Contacted: :i:J .a.. / -L..L
Date FOIL fulfilled or denied: .s-/ .dt Ll.
Closed by:
c&f3
Date:
/
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Notes: ~III (c.. rt.€ 11.iJ) S J-
Amount Due: Pages for a total of $ , .:S( J
Name: -.fYl ~ l[C 0 Ct VI
Address: N"2:3f~'-< q~
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o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (
Email address:
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FAX #: (
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SPECIFIC DESCRIPTION OF ~CORD:
01 -<l
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