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129FOR INTERNAL USE ONLY
Received by: on
Jessica Fulton
Date Received: I Q / ~ /
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:
(init)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: / /
Closed by:
Date: ~D / 7 / 1 ~
Notes: _ ~ fny ~ZQ,~j.~~
J
Amount Due: Pages for a total of $
Name: ''~ VJ ~,(~ e-,~ ~,~ ~ ^ check here if you are
Address: s requesting that the records
~~'` i-~ t o ~ be mailed to this address.
Agency or firm: ~~~is~~.S ~},~,
Telephone #: (mss) ~~. ~g FAX #: (~~~) ~_ -~pg~
Email address: .n.I~' ~! { S.~-PNj~t'$ ~~ or0 ~ ~ Nt.
SPECIFIC DESCRIPTION OF
.,-
~-
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
