132FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ /~ /
FOIL Ser. #:
DEPARTMENT: _ /
ASSESSOR r ~
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 '`~=~- / -
Closed by: ~~ r 4 $ 20;;
~~ ~'1'" 0~= i ~
Date: s~~ ~ c ~:~,~ pe„>l - l
Notes: ~~ FI~~
Amount Due: Pages for a total of $
Name: 1 ~ check here if you aze
Address: ~ ~ requesting that the records
be mailed to this address.
Agency or firm: '
Telephone #: (~ )~ - FAX #: ( _
Email address: Jam{ p~ /l~ ~ ~~ ~ , (~' ~,~
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