118FOR INTERNAL USE ONLY
Received by: Christine Fulton 0 /
Jessica Fulton
Date Received: g / ~ / /3
FOIL Ser. #:
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 p
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / ~
j
Department Head approval: _
(init)
Date Applicant Contacted: ~ /`~/
Date FOIL fulfilled or denied: ~ / a 0 /
Closed by: ~~~~i(/
Date: ~ j~ /~
Notes:
Amount Due: P -for a total of $
Name: ~n ~S~ ~~I/ pit ~' ^ check here if you are
Address: 8' 9 t ~¢, n ST, requesting that the records
3~ ~7/ /1/ ~ e?SL be mailed to this address
Agency or firm:
,e ~ a r-,v Ti ~+
S E~ ~- ' .
Telephone #: ( 8'Ys') g q~ - 0 0o FAX #: (~'~.s') ~_ G 3 3 7
Email address: Da~,se. F,Pfinel f~ZO O2v~'~r/~H~SeK/S.con~
SPECIFIC DESCRIPTION OF RECORD:
S u d e y y~ / G .f- S! gr~ ,eac,~ ti~ ~~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 a-mail to the address listed above
^ I request that the records be faxed to the number listed above