166FOR INTERNAL USE ONLY
Received by: Michael Leonard
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 ^
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: ~ / ~ / ~-
Notes:
Amount Due: Pages for a total of
Name: ~ t o~ T ao~~~ ~ ~ ^ check here if you are
Address: S QNG(r•' vu requesting that the records
7,-~~~, h~.~( ~ t n~~ 1l be mailed to this address.
Agency or firm: as vr~ ~~
Telephone #: (2v3 ) 3 3 FAX #: ( ) -
Email address: oo~~ a~d0 • Co~^-i
SPECIFIC DESC/l RII'TIO,~ OF RECORD:
~~OnOr.~,. /X PS/ri t~f`mh /fig/~S . ~u~ ~/~«'f4 f~~""h~
FORMAT OF RECORD (if available)
^ I request to be notified when I can come to inspect the record
~ I request copies of the records described above and agree to p
accordance with the fee schedule on the back of this applicati
^ I request that the records be sent via a-mail to the address list
^ I request that the records be faxed to the number listed above
S~~SSa ~