16259 y6v
FOR INTERNAL USE ONLY
Received by: Michael Leonard
Jessica Fulton ^
Date Received: ~ / a'S / ~~~ ~
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 + / ~~/ 13
Department Head approval:
(init)
Date Applicant Contacted: - / _ /
Date FOIL fulfilled or denied: - / _ /
Closed by: .~ ~ ~
Date: ~ / a S/ ~3
Notes:
Amount Due: ~ Pages for a total of $ 0., ~D
Name: ~re~ G ~ a~ ~S ^ check here if you are
Address: '` E~' ~~~~~`"' ~ requesting that the records
m `~ be mailed to this address.
Agency or firm: ~'-~~
Telephone #: (~.~) ~- ~~~~ FAX #: ( ) -
Email address: ~'~ JQ'z~- s ~~'~ ~~ ~r~~n " n ~ ~
SPECIFIC DESCRIPTION OF RECORD:
/~ 5 ~
.,f ~
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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above