035
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by:
Christine Fulton g..
Jessica Fulton ~
Date Received: ~I !!il /9---
FOIL Ser. #: ~
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING ~
ZONING ~
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREA TION 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:
I I
(init)
Date Applicant Contacted:
I I
Date FOIL fulfilled or denied: - Pu / _
Closed by: ~
//
Date:~/J11
Notes: 'J}
Amount Due:
Name: W \ \ \ "a,~ <;;.~'\ b
Address: 3 S7 ~ ~V-\t:- S-'2.- S':+Ol'.......~ 1 \~ tv '-I
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone#: (9c.1S) 70~ I Z-b I FAX#: ( )__
Email address: .s +"\ ~ b <2 .~ '\ e... tve +-
SPECIFIC DESCRIPTION OF RECORD:
!~ J-k~I~~;\-~%~~n D ~ 51 )tu~ ~/
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