003
Received by:
Christine Fulton 0
Jessica Fulton ~
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received: Ol / 0'1/ {bt'2
FOIL Ser. #: ()ct:>
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT ~
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 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:
() 'yP
Notes! C6 pI
Pages for a total of $
Amount Due
Name:~~~",~ ~'~-..~~~
Address: "l".()~ \\-...~~ ~ ~~.
Agency or firm:
Telephone #: (eHs ) <!Fj b - ~O b FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD:
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~C::,e:., '" ~ \\-.c....n1O ~ ?~\ ,,\~\<\~~ ~ ~
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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