265
FOIL Ser. #:
Chris Masterson 0
Christine Fulton ~
Sue Rose 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES ~/
RECREATION B'
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: 10 / /3/ 11-
C9
Closed by:
Date:
10 /, 3/ ((
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Notes:
Amount Due:' Pages for a total of $ J ... 'J ?)
Name: ~j..N ~"J Ii I v'lN
Address: ~71 ~ ,,0( (" I- (Y7~ I tv ~f
Nlll~). PAI/~ lV."!. {).57()
Agency or firm:
Telephone #: (qlq ).2Q:L- P)./7 FAX #: (
Email address: ' ) g . . ~
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
A
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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