211
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 0
Sue Rose ':9-
Date Received: L / ~ / ~
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 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: _ / _ / _
Date FOIL fulfilled or denied: <6 /~ / ~
Closed by:
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Notes:
/ /
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Amount Due: ~ges for a total of $
Date:
Nmne: g1~~ o che<kh= if you are
Address: ': ' / requesting that the records
. ~.f, . : - n~l. he mailed to this address.
Agency or firm:
Telephone #: ( 'if/; ) c2!i.2- 1,?fI ~ FAX #: ( ) --
Email 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