145FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~/~j
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 ^
Name:
Address: , (J~
Agency or firm:
Telephone #:
Email address:
- FAX #: ( ) _
FO T OF RECORD (if available)
^ 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
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:
/ /
Notes:
Amount Due: Pages for a total of $
" - ` _ ~ ~^ ~ ^ check here if you aze
~' ~ requesting that the records
~~ - ~9-SC~ ~ be mailed to this address.