031
Received by:
Christine Fulton ~
Jessica Fulton "
9-IJO/Jf}-
03L
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
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
(init)
Date Received by Dept
Department Head approval:
1 1
Date Applicant Contacted:
1 1
Date FOIL fulfilled or denied: ,-1 /
Closed by:
/
Date: RI ~I /2-
Notes:fhpo0J -~ -'itM{JfJ
Amount Due: Pages for a total of $
Name:
Address:
~S-(~....., \.-. '\l I? ~De
Agency or firm:
Telephone #: c9ltS) ~- O~~"l FAX #: ( )_-
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
o I request to be notified when I can come to inspect the record(s) described above
o 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