136FOR INTERNAL USE ONLY
Received by: Christine Fulto'h ^
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:
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: / /
Closed by:
Date:
/~~/ ~7/ ~
Notes:
Amount Due: Pages for a total of $
Name: ~I~y ~~~~~ ^ check here if you are
Address: ~pz..~ /Zau-~ 9 A7ocRa'~I requesting that the records
/.(~i~p~~~~r;~c' e~641 J,~c A~y• ~i,SQ be mailed to this address.
Agency or firm: ~L 6-~/ ac - = ti
Telephone #: (gi.~~ -~~ FAX #: (~'~') ~- ~~~
Email address: ~~" d~o3
SPECIFIC DESCRIPTION OF RECO~tD:
F AT 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