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147FOR INTERNAL USE ONLY Received by: Christine Fulton ^ Jessica Fulton Date Received: ~ /,~/ FOIL Ser. #: ~_ DEPARTMENT: ASSESSOR ^ ACCOUNTING ^ CODE ENFORCEMENT ^ PLANNING L~ 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 /~ /a ~ / /~ Department Head approval: ~!~ (init) Date Applicant Contacted: / O / o? ~/ Date FO fulfille r denied: ~~ / Z ~/ ~J Closed by: _ Date: ~" ~ ~ ~ / //~ G~ ~ Notes: ~ ~ -'~d Amount Due: Pages for a total of $ Name: ~ ~ L® l~~ L ~~ % L check here if you are Address: (S!f CG.~- ~ ~ ~ requesting that the records ~'^ ~L ;~J"-C /V - ~ be mailed to this address. Agency or firm: bt/ ~ ~ ~ ~"~' Telephone #: ( 5"') o~- FAX #: ( ) - Email address: jf ~ ~ rf (~ /Q- D L. ~ Cp M SPECIFIC DESCRIPTION OF RECORD: _5 v/~ vE-y nil ~ ~' ~ ~ ~' p Ro ~'~~ `t ~ ~ ®c~9 ~-~.~ ~ 7 f t ~. 5' ~©v7 ~' 3~~P/'1~vG ~l~.5 Fir~.1., 5 , ~ ~ i 25 9 d ~~ ~! -' l J FORMAT OF RECORD (if available) ~^ I request to be notified when I can come to inspect the record(s) described above 19/ 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-mail to the address listed above ^ I request that the records be faxed to the number listed above