007
FOR INTERNAL USE ONLY
Received by:
Christine Fulton ~
Jessica Fulton 0
1_I1.Q) I'd-
'1
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
o
o
o
o
o
o
o
o
o
~
Name:
Address:
Agency or firm:
Telephone #: (
Email address:
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:
I I
(init)
Date Applicant Contacted:
I I
Date FOIL fulfilled or denied: L I {j I I ~ .
Closed by:
@
LIlLIL2-
Date:
Notes:
Amount Due:
Pages for a total of $
o check here if you are
requesting that the records
be mailed to this address.
FAX#: (
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SPECIFIC DESCRIP~ RECORD: .~ c(:
aLd 17l~ ~ (O~~~ cl.~
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