1412009-10-16 JCM
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica~),plton
Date Received: / ~ /
OCT
FOIL Ser. #:
~~~~ ,_ ~ . ~ ~,, ~ - . , r
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 ^
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 ~~~~' /
Closed by: Q C T ~ ~ 2.013
Date: ~ ~ ~ ~ ' 7~
r._.., ._. .. ,. •_
Notes:
Amount Due: ~ Pages for a total of $
Address:. T-`-~ ~~~~1` ^ check here if you are
-` requesting that the records
a be mailed to this address.
Agency or firm:
Telephone #: (~ y 5 ) ~ f~- foO( FAX #: ( ) -
Email address:
S4P~ECIFIC DESCRIPLTION OF RECORD: (~ n A
a ~~1 c~ W ~ .n a
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