161FOR INTERNAL USE ONLY /
Received by: Michael Leonard L
Jessica Fulton ~
Date Received: ~~ 1 ~ ~ J aO~ ~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING J
CODE ENFORCEMENT ~.
PLANNING ,~
ZONING
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR
TOWN CLERK ^
W ATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN QF WAPPINGER
Application for Public Access to Records
F(.~IL REQUE~'T
FOR DEPARTMENT USE ONLY
Date Received by Dept _ / _,...,. I _
Department Head approval:
(init)
Date Applicant Contacted: _ / - /
Date FOIL fulfilled or denied: J / I
Closed by:
Date: ~~ / l~ J ~,~
Notes:
Amount Due.: Pages for a total of $
Name: ~ r~l ~,~-t ~.. C check here if you are
Address: ~.~ ~~ t~.i(JGt~~_I~~f~ ~ requesting that the records
~,~~~1'``~ I _ ~U`?, be mailed to this address.
Agency or firm: 1 ~ N ~,,~~ _Vtr~:~r-t ~,~; ~ ~r~-2~Yt.+~ i~~~_ ,
Telephone #: (~r~ 5) ~3 ~- ~ FAX #: (8 ~ 5) ~.-X72-~7.
Email address: r'-T~ s r-~nEl` L~t i n~ ctifi` ' h ~'~''''
SPECIFIC DESCRIPTION OF RECORD:
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TAE.. -'~~.~..E,r..~ ~, 2cr~ ~ Is i ~~ fca c3~ - Cs~ i S `~ --~'~ 2 - ~ ~ ~ ~caC~
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 cast 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
r I request that the records be faxed to the number listed above