137FOR INTERNAL U5E ONLY
Received by: Michael Leonard ^
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
0
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:
(mit)
Date Applicant Contacted: /~ // d / _.L_3
Date FO fulfilled or nied: ~C~/ / U1
A
Closed by:
Date: n~O/ ~ /
Notes: ~~U n ~ S~ //~/X Di~1~
Amount Due: Pages for a total of
Name: RFZYA,t1 (.,7. t~l OG Et ( ~.IG. ^ check here if you are
Address: requesting that the records
be mailed to this address.
Agency or firm: C t~l~ L S ~ A S PO 12 TS yl/1 ~ ~/ ~ SS
Telephone #: (~ 9 ~ y) ~_ 7 q S a,,, ; FAX #: ( ) -
Email address:
SPECIFIC DESCRIPTION OF RECORD:
G ooy c~fi' OR i~ iN ~L S' i 7 ~' P~ AN
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