029
Received by:
Christine Fulton ~
Jessica Fulton D
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
Date Received: t2d /0 C( / /r;).
FOIL Ser. #: () q
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
a2/d1$
Date Applicant Contacted:
I I
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Date FOIL fulfilled or denied: ~ / L / I fA
Closed by:
Date:
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Notes:
Amount Due:
Pages for a total of $
Name: ~ $ elf ~~LZ-
Address: )-f i (1 / t/e-
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Agency or firm: i"
Telephone #: (?{5J -- - 75 ~2.- FAX #: (
Email address:
D check here if you are
requesting that the records
be mailed to this address.
)--
IFIC DESCRIPTION OF RECORD:
of
FORMAT OF RECORD (if available)
D I request to be notified when I can come to inspect the record(s) described above
D 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
D I request that the records be sent via e-mail to the address listed above
D I request that the records be faxed to the number listed above