159FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: 1' ~ / 7 / ~'~
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 ^ / _ /
Department Head approval:
(init)
Date Applicant Contacted:
Date FOIL fulfilled or denied
Closed by:
Date:
_/-/
/ /
~/ 7/ /~
Notes: D C.v /
Amount Due: Pages for a total of $
Name: ' / ~ (e ~ ' U ~ check here if you aze
Address: ~ 3J ,~~ .~,,,,.( ~-,,., r requesting that the records
n,ind~~ P6,~ (', /b'y___/Z~ZY be mailed to this address.
Agency or firm: `r~s~-t~yl 1~hu. (,v~.,Q,~./'
Telephone #: (5 ty~) ~(~~ -:3Yb~F FAX #: ( ) -
Email address:
SPECIFIC DESC~RIP'T~O/~ OF RECORD: ~j
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
0 I request that the records be faxed to the number listed above