225
Received by:
Chris Masterson 0
Christine Fulton . J
Sue Rose Y
-1./ ;,3.1 JL Cj
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
O~y
FOR INTERNAL USE ONLY
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT ~
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 L / ~
Department Head approval:
. lID I
Date Applicant tacted: .Q; /J-r L
aenied: [" I
Closed by:
Date:
/
/
Notes:
Amount Due:
Pages for a total of $
Name: ~ (1... t.v ~.i \) o..,J,'-Jl ~ ;(. 'Z.4~
Address: I ~ 'l-O lvM \-/-/ ......."T-i>.~ ~
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Agency or firm: f...:Jy 5 <U \:.....(1 r O~ {' U/\ I\.I..,.-,...,n ,j.J J
Telephone #: (~~~ ) 7.:. l.- - s--o ':>1 FAX #: ( ) _-
Email address:
o check here if you are
A....8 fJi'-'f requesting that the records
,I'-'-f be mailed to this address.
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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
B- 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