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028
FOR INTERNAL USE ONLY
Received by: Christine Fulton Lt
Jessica Fulton 0
Date Received: 0;) /oQ/l?-
FOIL Ser. #: ,':).9
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT ~
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
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
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
(init)
Date Applicant Contacted:
/ /
---
Date FOIL fulfilled or denied: ;It I
Closed by:
/
Date: eX / 51 / / d..
Notes:
Amount Due: ~ Pages for a total of$ .2,00
Name: '11fS oN D~ DIe>
Address: 0'.1C- SCflRf3of(OR4-! L../?
Vt//lPfJllVC-/;'1{ s FIl^1- NV IQ..J70
,
o check here if you are
requesting that the records
be mailed to this address.
)--
SPECIFIC DESCRIPTION OF RECORD:
~\~(()~ 2:') cfP.AU\ llZon 0.[1 l=>u fl'l is ~ I~d, "'SirLL
\) u - ~ -20 I () -To '\){' C- se...n + .
RECEIVED
FEB 0 9 2012
FORMAT OF RECORD (if available)
, lJ<;r Me IVI!:,,, I
TOWN OF WAPPINGER
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
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
o
o
