030
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by:
Christine Fulton 0
Jessica Fulton ~
Date Received: ~ / J1l / l!1
FOIL Ser. #: 0 BrJ
DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~
CODE ENFORCEMENT
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
/ /
--
(init)
Date Applicant Contacted: / /
---
Name:
~ Address:
i1JO
.. Agency or firm:
Date FOIL fulfilled or denied: / /
Closed by: J
Date: L/~/u
Notes: /6 6 6Jfc/ 13, 7 S-
Amount Due: _ Pages for a total of $
~ check here if you are
/ 1:;-; y requesting that the records
J.- .[)()- '\ be mailed to this address.
FAX #: ('Slip) -lf3;2(
SPECIFIC),Df:SCIpPTION OF RECORD: .
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I
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6 6J57-01 -31tJ'RYl/
FORMAT OF RECORD (if available)
o 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
o I request that the records be sent via e-mail to the address listed above
o I reguest that the records be faxed to the number listed above