220
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
CC;
Received by: Chris Masterson []
Christine Fulton iJ
Sue Rose ~
Date Received: R- / l / 11-
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING [J
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR !&f
TOWN CLERK 0
WATER/SEWER [:J
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEP AR TMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
(init)
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied:
/
/
Closed by:
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.x / 22) 2.a!.',
/11(') (.I/;~'-/-e ~M
Date:
Notes: ../J {)...-\)-(.
Amount Due:
Pages for a total of $
Name: Michael C. & Annette R. Schrenkel
Address: 25 Chelsea Road PO Box 140
Chelsea, NY 12512-0140
Agency or finn: SELF
Telephone #: ( 845 ) ~- 1941 FAX #: ( )
EmaiJ address: scbrenke1@a()Lc;9lJ:lm
[I check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: Any and an documentation related to the above named
person(s) and property held by the department checked above. Including, but not limited to notices,
correspondence, memos, reports, records of surveillance and/or visits, photographic images captured
during those visits, notes made during those visits, and any other documentation pertaining to alleged
code violations at the above address.
FORMAT OF RECORD (if available)
I request to be notified when 1 can come to inspect the record(s) described above
1 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
t!{ I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above