123FOR INTERNAL USE ONLY
Received by: Town Clerk
Jessica Fulton
Date Received: ~ / ~/ ~~ ~ ~~
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 ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval.
Date Applicant Contacted:
Date FOIL fulfilles~ ~~~ /
closed by: SEP 1 p 2013
Date: TO~'~N ®~ ~~1~p~'~1~1/
ASc~~~~'~~, ~'
Notes:
eon a ~ .s- 7
Amount Due: ~ Pages for a total of $ 3,0 ~
____
Name: ~ t ~~ S'c u nt- ^ check here if you are
Address: 3.~ ~ left ~ ~' %+ ~~ requesting that the records
`~ ~Q ~ .~ '/ L ~ ~~} be mailed to this address.
Agency or firm: ~r~ /~ ~ f"h ~~~rNcx
Telephone #: (SI ~ ) G G~ - y o y FAX #: (s/ ~ ) ~- 3 S ~ ~~
Email address: _. ~I-c~P~i u/ s ~ ~= ~ n,~ cai~ . r ~, c:u~H
SPECIFIC DESCRIPTION OF RR~~CORD: ~o~q
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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
