157FOR INTERNAL USE ONLY
Received by:
Michael Leonard
Jessica Fulton ^
Date Received:
FOIL Ser. #:
1( /~/~
f3~
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 ~ / ~ / ~ 3
Department Head approval:
(init)
Date Applicant Contacted: f ~ / '~ /
Date FOIL fulfilled or denied: ~ / ~/ ~~
Closed by: ~~`~
Date: / L / ? / ~~
.~ S
Notes:
Amount Due: Pages for a total of $
Name: ~avr-¢a V/- ~~sl~, . ~r ^ check here if you are
Address: ~-f ~S Nan+ ~ I -tr--~ ,Q~~ ~ ~ ~o~ requesting that the records
~_ / ~A P)_..:,h~ ~ I ~ ~o i be mailed to this address.
Agency or firm:
Telephone #: (S i~/ ) 220 -~ AX #: (S• ~I )~~ - ~ ~~
Email address: . ; ~o.-ko~.~s/~-'~ ~ ~~ ~a~• C-ow~
SPECIFIC
K OF RECORD:
,. ~ i
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