021
FOR INTERNAL USE ONLY
Received by:
Christine Fulton M.
Jessica Fulton 0
Date Received: L / Jl / I ~
FOIL Ser. #: C)}
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREA nON )b
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept L/W. . OIL
Department Head approval:
lDlt
Date Applicant Contacted: 1- / .M. / 2.Ol L
Date FOIL fulfilled or denied: \ /31 / 20, l
Closed by: ~ AtPe!<.E
Date: -L / !i / 21Jt Z.
Notes:
Amount Due: f L~Pages for a total of$ ,"Z.~
Name:-::s""",~ ~u \\ ,v ""~
Address: ;;:>,1(;' ~\ ~~,fo,) ~,
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Agency or firm:
Telephone #: (<111-( ) ~- e9OJl/ 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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FORMAT OF RECORD (if available)
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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 .
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above
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