223
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 8t
Date Received: f I JL I ~
FOIL Ser. #:
1f 61&3
DEPARTMENT:
ASSESSOR D
ACCOUNTING D
CODE ENFORCEMENT D
PLANNCiNG D
ZONCiNG 0
FIRE INSPECTOR D
HIGHWAY D
RECEIVER OF TAXES D
RECREATION D
SUPERVISOR D
TOWN CLERK la-
WATER/SEWER D
DOG CONTROL OFFICER 0
TOWN ENGINEER D
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ I /1 I I (
Department Head approval: ~ 11'_
-~-
Date Applicant Contacted: l I LL I I.L
Date Fe denied: <t / ~ / I(
Closed by:Pvf.6-
Date:
!LI -'I1-1L
Notes:
Amount Due:
Pages for a total of $
Name: 14 fZt
Address: (.~';-:; ~~Vi {~ /\-1
Agency or firm:
Telephone #: C~l/Jf.f/.l1t..- )"77)FAX #: ( )_-
Email address:
o check here if you are
requesting that the records
be mailed to this address.
S'lgIFIC DE~CRIPTIO%F RECORD: W
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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
~ 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 ofthis 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