309
FOR INTERNAL USE ONLY
Received by:
Chris Masterson
Christine Fulton
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Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0'- 3 () 1
ACCOUNTING 0
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PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECENER OF TAXES c{
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
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Name: '
Address:
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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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:
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Closed by: 1).- ]
Date: i~~J'.
Notes:
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Amount Due: _ Pages for a total of $
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm: t;h ({ (/t1~ l~1'bn c/-e-
Telephone #: ([7'51 t:lL- ~ r 3 G FAX #: (
Email address:
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SPECIFIC DESCRIPTION OF RECORD: j '.' t1 j
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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
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