148FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~~ / a~ / / ~
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 ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept /b l a~fl l/~
Department Head approval: iyG--
(i rt)
Date Applicant Contacted: /O /~ / /~
Date FOIL lfilled r denied: ~6 / ?~/ /~
Closed by:
~'.~
Date:
Notes:
ld / Z~/ /3
Amount Due: Pages for a total of $
Name: ~- ~ ~ ~ ^ check here if you are
Address: requesting that the records
S4 ~ ~ be mailed to this address.
Agency or firm:
Telephone #: (~K,~ 'r- - ~S FAX #: ( ) -
Email address:
SPECIFIC DES RIPTI N CORD: ( _
Sp D - O 9~
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 e-mail to the address listed above
I request that the records be faxed to the number listed above