124FOR INTERNAL USE ONLY
Received by: Christine Fulton 0
Jessicrva-~~F~~u''lton
Date Received: ~ /OcV/
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 ^
Name:
Address:
Agency or firm: `13~C~ R~
Telephone #: (~ [~) ~/S(Q _
Email address:
SPECIFIC DESCRIPTION OF RECORD:
r
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ /o? O / /,~
Department Head approval:
(init)
Date Applicant Contacted: ~ / .Z 0 / ! ~
Date FOI fulfilled r denied: ~ /~U/ ~
Closed by: /~ CY
Date: l /aQ /
Notes:
Amount Due: Pages for a total of $
V `~v ^ check here if you aze
~ ~~ requesting that the records
~'~'j be mailed to this address.
FAX #: ( ) _
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