257
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
S'tf Rose 9'
-/-1.301 JL
'::It cY( j 7
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT ~
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENEROFTAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN A TIORNEY 0
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Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
Date Applicant Contacted: I I.:3CJI [I
Date F~~or denied: L 13 () 1 ft.
Closed by: 11 ~
Date: I 0 ~ .l- / i3 Oi.JL
Notes: {'J eO f ~
Pages for a total of $
Amount Due:
Name: ~hd(O lL t:="l'J1os.
Address: t\~. PLa.,r\ s.+ ~ 1~.lo
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Agency or firm: Lc So ,~t .
Telephone #: (~\ % t ~o- ~ FAX #: (S'~ ) ~- q,OY
Email address: Cl ev,Os.~.d'c:lcf'Q)n~ul-has.. CcN\ /5 - DJ - 37535
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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