213
FOR INTERNAL USE ONLY
Received by: Chris Masterson ~
Christine Fulton 0
Sue Rose 0
Date Received: ~ / 5 / lL
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOIL Ser. #:
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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 r.g..-
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN A TIORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: P /~ / J...L
Closed by: ~
Date:
/ /
Amount Due:
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Notes:
Name: /J1~~~eY/~L-
Address: L~di;; Rdiks (f.1J:If IV ~
Agency or firm: S' J; t- ;:
Telephone#:(8i1512:!lL-703"11- FAX#: ( )_-
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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