FOIL Request Form
Received by:
Christine Fulton 0
Jessica Fulton 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
/
/
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREA TION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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:
Address:
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (
Email address:
)--
FAX #: (
)--
SPECIFIC DESCRIPTION OF RECORD:
FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record(s) described above
o 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
o I request that the records be sent via e-mail to the address listed above
o I request that the records be faxed to the number listed above
2009-10-16 JCM
The Town of Wappinger has designated the Town Clerk, by the adoption of Resolution No. 43 of 2002, as the Records
Management Officer (RMO). It is the responsibility of the RMO to ensure compliance with the Freedom of Information law.
The Town Clerk's Office houses many of the Town's records and maintains a subject file index of those records. However, each
individual Department within the Town of Wappinger government maintains records specific to their office and is designated
custodian of such records.
Active records are located at the Town Hall, 20 Middlebush Road, Wappingers Falls, NY, 12590. Hours of operation for the
Town Hall are 8:30 AM to 4:00 PM, Monday through Friday, excluding holidays named at each Reorganization Meeting and other
times during which the Town Supervisor, or other authorized official, directs the Town Hall to be closed, such as for inclement
weather or other emergency.
FOil request forms are available at the Town Clerk's Office. To make a request for access to records, fill out the
application to include the following:
. Name
· Agency or Firm (write "self" if making the request for yourself)
. Address of applicant
· Telephone number of applicant
· Fax number of applicant
· Notate if you would like copies of the records or would only like to inspect the records
· A SPECIFIC description of the records being requested
FOil requests can be faxed, emailed, mailed or dropped off at the Town Clerk's Office. If records are being requested
from multiple offices, submit separate requests for each.
The cost for copies of records is $0.25 per page for paper copies up to 9" X 14". Copies for most other records will be the
cost of reproduction. Other costs will be calculated in accordance with 587 of the Freedom of Information law.
Upon receipt of a FOil request, the RMO will assign the request a serial number. The request will then be entered into a
database and forwarded to the appropriate department. Within 5 days after the receipt of the request, the responsible department
will make such record available to the person requesting it, deny such request in writing or furnish a written acknowledgment of the
receipt of such request and a statement of the approximate date, which shall be reasonable under the circumstances of the request,
when such request will be granted or denied. The approximate date will be within 20 days of the date of receipt. If the request
cannot be fulfilled within 20 days, the department will provide the requestor with an exact date that the record will, wholly or in
part, be provided or made available.
The RMO may require the requestor of certain FOil requests to sign an affidavit that information being provided will not be
used for solicitation or fund-raising purposes and that the requestor will not sell, give or otherwise make such information available
to another person for the purpose of allowing that person to use the information for solicitation or fund-raising purposes.
A requestor may ask that the Town Clerk certify records being requested. Such requests will require that the requestor pay
the appropriate fee for certified copies as set forth in Chapter 122 of the Town Code of the Town of Wappinger.
If a request is denied by the RMO or appropriate custodian, the requestor may appeal such denial within seven business
days of receipt of denial. Appeals must be submitted in writing and sent to the RMO.
The information provided here is posted to assist you with your FOil request. It will be updated as needed, but is always to
be considered subordinate to the Freedom of Information law and the Town Code of the Town of Wappinger. If at any time, the
information posted here contradicts the Freedom of Information law or the Town Code of the Town of Wappinger, the information
posted here is to be deemed invalid.
or nterna se my
Staff Member Phone Number Called E-mail Address (if applicable) Date Messa~e Left (Y/N)
Record of Attempts to Contact Applicant
F I I U 0 I
Notes & Comments