164FOR INTERNAL USE ONLY
Received by:
Date Received:
Christine Fulton
Jessica Fulton
/ /
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 ^
Address:
Agency or firm:
Telephone #:
Email address:
SPECIFIC DESCRIPTION~OF
. ~(/~L t-
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FAIL REQ UFST
" . '~/,fir o%i~3~~8
FOR DEPARTMENT USE ONLY
Date Received by Dept _ / - /
Department Head approval:
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: / /
Closed by: '
Date: / /
Notes:
Amount Due: ages for a total of $
check here if you are
requesting that the records
be mailed to this address.
- `.`~ j~ FAX #: ) - I
`~ N d~~v
~- ~~ y
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