1182009-10-16 JCM
FOR INTERNAL USE ONLY
Received by: Chris Masterson
Christine Fulton
Sys Ros ^
Date Received: 1 /~/ / ~
FOIL Ser. #: ~ ~ R
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~/ ~ / ! Z
Department Head approval:
(init)
Date Applicant Contacted: ~ / 2 ~ / ~
Date FO filled r denied: ~ / Z ~ % / Z
Closed by: ~"-( ~Y
Date: ~ / Z SS / / Z-
Notes:
Amount Due: Pages for a total of $.
Name: i"r ~ ~ `' ~ ~- c-~`~'''~ Z-- ^ check here if you are
Address: Z L %~-~.~-c. p~--~ ~- ~¢ ~'( requesting that the records
,~.~_ /~ ~ / ~ a ~' be mailed to this address.
Agency or firm:
Telephone #: (9'/ ~/) S'dP 1- cfa ~ FAX #: ( ,) -
Email address: ~+ c ~ .~-c ~Gt- i c,~ ~jJ s',~ - c~ ^~
SPECIFIC DESCRIPTION OF RECORD:
h-~ 3 l~-fie.. ~? l~ - t~"~
ti
F/ORMAT OF RECORD (if available)
C~' 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