235
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose p-
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$ 19/30
2009-]0-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
of( ~AP,.
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FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT V
PLANNING 0
ZONING D
FIRE INSPECTOR D
HIGHWAY 0
RECEIVER OF TAXES D
RECREATION D
SUPERVISOR D
TOWN CLERK D
WATER/SEWER D
DOG CONTROL OFFICER 0
TOWN ENGINEER D
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
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(init)
Date Applicant Contacted: ~ If'j 1 ~
Date FO~denied: L IIff I (I'
Closed by: IL( 6-
Date Received by Dept
Department Head approval:
Date:
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Notes:
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Name: V 51lA.{ 'I (} fL 0 check here if you are
Address:~~T~)AD t1/~t"?A,q n;~/} It/V 115'-90 reque~tingthat.therecords
'iA I 17 /351 gq- ~a5 -Of(.. ~'-;]()?s-(,wO be matled to this address.
Agency or firm: '1)ltXl:.; 2.. t c' r: 1"/.3
Telephone #: ( ) _- FAX #: ( ) _-
Email address: b w I\~ 'Tit u" . ., 'U/(l dll., C:OYh
Amount Due: . 2~ Pages for a total of $ ,2- 5
SPECIFIC DESCRIPTION OF RECORD:
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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
Q-- 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