033
FOR INTERNAL USE ONLY
Received by: Christine Fulton ~
Jessica Fulton
Date Received: fJ- / 1!3 / fA
FOIL Ser. #: #S8 ;n
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DEPARTMENT: ~
ASSESSOR ~
ACCOUNTING
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREA nON 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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I?~R DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
Date Applicant Contacted:
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Date FOIL fulfilled or denied:
Closed by:
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Date: / /
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Amount Due: Pages for a total of $
Name: C~'" "J 0.. ~
Address: _~ :; lH' + I ~ (( l) c Ie- ~ C>\.N' i
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Agency or firm: ~ \ r ~ S:t lJ'r- \.
Telephone #: (3'ceo ) ~- ((.f 9 S'" FAX #: (
Email address:Jo,,-, (.. COV1l-jo.~ ~ '10 I.,bv. C~f'-1
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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
