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280 FOIL Ser. #: Chris Masterson 0 Christine Fulton 2/ Sue Rose \ ~ &/:Jf/~ / -WcP80 / 2009-10-16 JCM TOWN OF WAPPINGER Application for Public Access to Records FOIL REQUEST FOR INTERNAL USE ONLY Received by: DEP ARTMENT: ASSESSOR 0 ACCOUNTING 0 CODE ENFORCEMENT 0 PLANNING let ZONING 0 FIRE INSPECTOR 0 HIGHWAY 0 RECEIVER OF TAXES J RECREATION 0 SUPERVISOR J TOWN CLERK J W A TERlSEWER 0 DOG CONTROL OFFICER 0 TOWN ENGINEER 0 TOWN ATTORNEY fJ Date Received: FOR DEPARTMENT USE ONLY Date Received by Dept &- / rJ'3:G/ Department Head approval: . (ini Date Applicant Contacted: 10 / d:l/ 11- Date Fo@r denied: (D feLl f R Closed by: i V , Date: !- 0 /D/ /1 Notes: Amount Due: /~ ~r a total of $ Name: Address: o check here if you are requesting that the records be mailed to this address. SPECIF~~~ti~r1CO~:(SI'CrI(L4,J ;U,J;i( k~!'Jfl 'r 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