295
Received by:
Chris Masterson 0
Christine Fulton ~
Sue Rose l)
jL/.J.j/ ~
3d9~
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR J
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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Date Received:
FOIL Ser. #:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: Jl-I fl/1L-
Closed by: / r ~
Date: J l~)
Notes:
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Amount Due: ~ Pages for a total of $ ( ,~C;
Name: 0/"1 I-b(;.,~l.-
Address: ~Oe; /'"1' ~^ 'r),5i~( ~.,#
~~~mfirm: Aj~~'~~V-
Tel~hone #: ( ) - 5"J?-f..AX #: ( )__
Ema11 address: . 7. ~
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD~ /' "". ':','
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FORMAT OF RECORD (if available)
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I request to be notified when I can come to inspect the record( s) described above
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 /.-
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above
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