228
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 [J/
Date Received: L/ /) 1-1!-
FOIL Ser. #: 1IJdrf
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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 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN AITORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
11 J5111-
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: ~ I 1 t)i J..L
Closed by:
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Date:
Notes:
Amount Due: ~ Pages for a total of $ t). S()
Name: .f~ W V ",l&.t,...1 'tn... ~ V"~ c,.f)
Address: 2) ( ~Q\tA... $"'- (\J ~~ c.J.JS.cA
Agency or firm: C l 1--1 (]~~
Telephone #: QU('"' )N--'"l. '2.13 FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD:
J (3 roo K::. P L ~ 7. ~ ~ .. 62 - ~ 'L S<i (t ,
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