212
FOR INTERNAL USE ONLY
Received by: Chris Masterson 0
Christine Fulton 0
Sue Rose g
Date Received: ~ / -L I 1L
FOIL Ser. #:
:ft f) / ;(
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
~ VJAPp
~~.~. . ,-..'-t.
~ /' ~ _~. ~'"'~t;'. "-
.0,' ..,'~
.~ . -,.
o'..~\~
c:. /2f!
, .....,.: . .' / .4.' ;
'-'.' . "'.
.:i.,,:.,-_ "......
'7~ss "cO~'I;""
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
(init)
Date Applicant Contacted: _ I _ / _
Date FOIL fulfilled or denied: <?' IS / .i.L
~.
Closed by:
Date:
I
I
Notes:
Amount Due:
/'
Pages for a total.off
Name: Zl~ ~J\YY\d~
Address: ~~" ~
l;..) , ~.Q 10 fl'~
Agency or firm:
Telephone #: ~~ r ) J,LL- 7 J 'i ;2 FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
/ d,')r.;
)--
SPECIFIC DESCRIPTION OF RECORD:
<:/1JiPf"
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