027
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by:
Christine Fulton ~
Jessica Fulton ~
Date Received: ~/ fa. / ~
FOIL Ser. #: ~.7
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONrnNG 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W~TER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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FOR DEPARTMENT USE ONLY
Date Received by Dept ~'/
Department He,~pproval: ~ ~
jl\\) ~ Y ~ (init)
Date Applicant Contacted: _ / _ / _
Date:
Notes:
Amount Due:
Pages for a total of $
Name: J ~ \./ 72vy~~ 0 check here if you are
Address: Zz... \J ~~ U~ _ requesting that the records
~~\I\lC'f.2(V\ ~ Y'^I 12 \'> 0 be mailed to this address.
Agency or firm:
Telephone #: flit ryt.cJ --IJJL FAX #: (crt y) ~-7~ 77
Email address: L- ~~:nJ11 ~ ~ 1..., ('~
SPECIFIC DESCRIPTION OF RECORD:
~RE~
FORMAT OF RECORD (if available)
o 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