108FOR INTERNAL USE ONLY
Received by: Christine Fulton 0 ~
Jessica Fulton ~/
Date Received: ~/ ~~..J
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING
ZONING ^
FIRE INSPECTOR 0
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATERJSEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
~ coP -
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / o~ ~~
Department Head approval: ~ ~~-
(init)
Date Applicant Contacted: ~ // Z /
Date FO ful ille r denied: ~r Z / ~3
Closed by:
Date: ~//Z /~
Notes:
Amount Due: Pages for a total of $
Name: ~ ~~ ~ c t~ ~ ~ ^ check here if you are
Address: 3 ~ t N S 2~ £~ requesting that the records
l~ Sk4-(L < <- ~- ~ ~ 2- be mailed to this address.
Agency or firm:
Telephone #: (~~b )~~- C~3~J FAX #: (~~~) ~1 ~-~S_~b ~o
Email address: (~~~~~~~ lJ~9e-e C~~t' • C~~-.
SPECIFIC DESCRIPTION OF RECORD: 2 2 Z a ~ p -Kv ~P ~. ~~ LL D
off' ~ ~C ~-
2c~t~w~
"C ~~ ~S
FORMAT OF RECORD (if available)
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