234
Date Received:
Chris Masterson 0
Christine Fulton ]
Sue Rose ~
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trJ5<f
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT ~
PLANNING (0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY []
RECENEROFTAXES []
RECREATION 0
SUPERVISOR J
TOWN CLERK J
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN A TIORNEY 0
FOIL Ser. #:
FOR DEPARTMENT USE ONLY
~ 1/5/ 1/
~
(init)
Date Applicant Contacted: r I I 5'1 / /
Date F~r denied: L II SI II'
Date Received by Dept
Department Head approval:
Closed by:
lilY
L I /~ IL
Date:
Notes:
Pages for a total of $
Amount Due:
Name:
Address~ .
~~ 6BI~ ~~
Agency or firm:
Te1ephone#: (~45 ) L.\71 - \~~O FAX#: ( )_-
Email address:~'('\Qt..J K (j) ~(~~fS . c.oWl
o check here if you are
requesting that the records
be mailed to this address.
"b~ \-\ r S
FORMAT OF RECORD (if available)
M.... 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