135FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
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 0
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 ~ / ~ / ~ 3
Department Head approval:
(init)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: ~ / ~ /
Closed by: ~ 2 ~_
Date: ~ / ~- /
Notes:
Amount Due: ~ Pages for a total of $ O • ~ ~
Name: ) fl S E P (.~ Cr l bV Pt tJ ~ C- TTY ^ check here if you aze
Address: ~ w ~ ..~ o Mi c-L 2fl . requesting that the records
Q. ~n ~ ~ ~~f r o SD be mailed to this address.
Agency or firm:
Telephone #: (9 ~ 4 ) 3'~,p - 2fl33 FAX #; ( ) _
Email address: '~ d ,e.Q ; b 22 Cd l_.,t...... ~.(_ ....--
SPECIFIC DESCRIPTION OF RECORD:
S vr1`(G-'~ nL y c-rGU~~pWtJ QD
FORMAT OF RECORD (if available)
^ I request to be notified when I can come to inspect the record(s) described above
,a' 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