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142)/18/2013 12:42 PM
From: EnTech Engineering PC / (646) 722-0000 Ta: 18452981478 1 a
FOR INTERNAL USE ONLY
Received by: Michael Leonard ^
Jessica Fulton
Date Received: „~ / z~~~~
FOIL Ser. #: ___~-~~d~
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER
DOG CONTROL OPTICER
TOWN ENGINEER
TOWN ATTORNEY
DEPARTMENT: ~„
ASSESSOR
ACCOUNTING -,
CODE ENFORCEMENT
PLANNING --~
ZONING -,,.
FIRE INSPECTOR
HIGHWAY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
1..~~~,~
0~~ ~,
FOR DEPA~tTMENT USE ONLY
Date Received by Dept _ / _ /
Department Head approval:
(init)
Date Appl leant Contacted: ,~„ / _,_,_ / ~„-,,
Date FOIL fulfilled or denied: ! /
Closed by: (,,- ~~
Date: Lp / d~/
Nolen:
Amount Due: Pages for a total of $
Name: Jp0.~~ ~(A5S heck here if~ you are
Address: ~~ ~~~~.t~~~~~1 , 7_~`~~ '~ tr~r,v requesting that the records
~1,~ , ~l~l 4tk~C)~t-l. be tnailed to this address.
Agency or firm:........ ~ ' t l:Y i. vtut `~'
Telephone #: (~,N (v) ~~- ~x,,~x~ #: ('Ll ~) ~ - r1~•
Email address: ik4.n:~4:w ~_ I~v~~l•Qr Ir, - i~}f. a ~~.~A
A~SeSSo~ [~ SPECTFTC DESCRIPTION OF RECORD:
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~,~~..
FORMAT OF RECORD (if available}
T request t~ he notified when T can came t~ 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 e-rttail to the address listed above
I request that the records be faxed to the number listed above
