009
. ....
Received by:
Christine Fulton 0
Jessica Fulton b
-L / -lC2.1 12-
C/cq
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Ser. #:
Date Received:
DEPARTMENT:
ASSESSOR D
ACCOUNTING D
CODE ENFORCEMENT ~
PLANNING D
ZONING D
FIRE INSPECTOR D
HIGHWAY D
RECEIVER OF TAXES D
RECREATION D
SUPERVISOR D
TOWN CLERK D
WATER/SEWER D
DOG CONTROL OFFICER D
TOWN ENGINEER D
TOWN ATTORNEY D
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
(init)
Date Applicant Contacted:
/ /
Closed by:
/
Date FOIL fulfilled or denied:
Date:
L / /0 / 1.2
1 ~[u) .
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 #: SfS ) Z~7 - 1-7 91' FAX #: ( ) -
Email address: 1<.. ~A (Z'f<R.. <; j 'L...'2.....3"3 ~ &MA 1 C " C. oY"'\
SPECIFIC DESCRIPTION OF RECORD:
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
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