165FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~/ ~ /
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 D
2009-10-16 JCM
TOUVN 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: /~ /~/ ~~
Notes:
Amount Due: ~ Pages for a total of $
Name: Job J ~~~ ~~ ^ check here if you aze
Address: °`' requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: ~ ) FAX #: (l ) ~' -~,S'1~
Email address:
SPECIFIC DESCRIPTION OF RECORD: ~\ n
C
C~
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