226
Date Received:
Chris Masterson
Christine Fulton
Sue Rose
XI /21 J..L
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT: _ /
ASSESSOR l1Y
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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FOIL Ser. #:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted:
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Date FOIL fulfilled or denied: I I
Closed by:
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Date:
Notes:
Amount Due: --3- Pages for a total of $ 0.. 7 5"
Name~ ~ .pcheckhereifyouare
Address: . . ~ n "."" C -/f reque~ that the records
, p-->?&malled to this address.
Agency or firm:
Telephone#: ~1"J).826- -7tJd(FAX#: ( )--
Email address:
SPECIFIC D~CRIPTION OF RECORD: tJ_
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FORMAT OF RECORD (if available)
0" 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 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