297
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Chris Masterson 0
Christine Fulton 0
Sue Rose(/, ~
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1fd9 7
Received by:
Date Received:
FOIL Ser. #:
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DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECENER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
o
o
o
o
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FOR DEPARTMENT USE ONLY
/ /
Date Received by Dept
Department Head approval:
--
(init)
I /
Date Applicant Contacted:
---
Date FOIL fulfilled or denied: I /
---
Closed by:
/ I
Date:
---
Notes:
Amount Due:
Pages for a total of $
Name:. f!J; fftiJS C; fff1t
Address: ~"i'~rJr - ).r.!. ,
Agency or firm: S
Telephone#: ( )J:S2.- 9~~ FAX#: ( )--
Email address:
o check here if you are
requesting that the records
be mailed to this address.
mC~~TION 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
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