032
Received by:
Christine Fulton 'iJ
Jessica Fulton 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received: d- 1 ) 3 1 801C1-- '
FOIL Ser. #: O.:5d
DEPARTMENT:
ASSESSOR 1J
ACCOUNTING 0
CODE ENFORCEMENT 0
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:
~/&)~
1'~.A-
(init)
Date Applicant Contacted:
1 1
Date FOIL fulfilled or denied: ~I f3 I)~
Closed by:
Date:
211"3 1 I ~
Notes:
Amount Due: --3- Pages for a total of $ () , '7 S-
Nmne:'~f\~ ~~
Address: (3 ~ 2" (' _ ~- -10 ,- (/0
Agency or firm: ~
Telephone #: ~'-\0 Z&'iL- ~ FAX #: ( ) _-
Email address: u..:~~L'SSe l \ 0....0 \ I ('~
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
d il A..
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