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149FOR INTERNAL USE ONLY Received by: Christine Fulton ^ Jessica Fulton ^ Date Received: ~ l o7U l FOIL Ser. #: I~ DEPARTMENT: ASSESSOR CY 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 ~ / ~ / (3 Department Head approval: (init) Date Applicant Contacted: _ / _ / Date FOIL fulfilled or denied: / / Closed by: iU /~~1 Date: (D l ~ ~fl I ~ Notes: Amount Due: ~ Pages for a total of $ a• 7S Name: ~ l j z0.b e`~~ ~~ d w ~ I l ^ check here if you are Address: g ~ M d,,~ k~ ~ Street requesting that the records J Iara©inae,t~-s -FCtIls~1~l~/ 1z5~jy be mailed to this address. Agency or firm: Telephone #: (6 ~~) ~ q 7 - 7 3 4 ~ FAX #: ( ) - Email address: 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