150FOR INTERNAL USE ONLY
Received by: Michael Leonard
Jessica Fulton ~ -
~~'
Date Received: ~ /~ /~
FOII. Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT 0
PLANNING ~
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY 0
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: ~ /3/ / ~
I/-/-~3 _
Notes:
Amount Due: Pages for a total of $
Name: ,5 ? ~ p ~,' ~~ ~' ~/J ~ rs s (~ check here if you are
Address: ~ c,~~ ~ ~ ,~ A ~. ~ requesting that the records
''''' p p 9 ^`' ~ ~'~~ ~ ~ pis be mailed to this address.
Agency or firm:
Telephone #: (~-ys) 2 qsr - z~_ FAX #: ( ) -
Email address: s , ~: , C,. a ,~. ~ a~ v~ ~ sc w ,~ ~-
SPECIFIC DESCRIPTION OF RECORD:
E+~v~e~;r~N't'~t~ ~M~.ACT 6TvAY
t ( ~ ~S ' f ~, C7 v cJ f~ l~ ~ w c. ~~ r~~
FORMAT OF RECORD (if available)
G 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
r I request that the records be faxed to the number listed above