036
Received by:
Christine Fulton ~
Jessica Fulton 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received: ~ / /5/ .;xJl6>
FOIL Ser. #: O.3lp
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
Date Received by Dept
Department Head approval:
/ /
(init)
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied:
Closed by:
~/2
)30 /YJ4 I
Amount Due: Pages for a total of $
Notes:
Date:
Name: ;r ~~,.J CO '-L
Address: I -:z. '5" c::; '--0 A..... ~ 4""'1 f' c> ;) -c ~
C~(Z.l~"';.-' Jl ~OJ~y.
Agency or firm:
Telephone #: (3'-fS ) ~- 39(.. '1 FAX #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
)--
SPECIFIC DESCRIPTION OF RECORD:
/2> 0 r-y f-. L.A",/L - W~ - e- '--L ,.,v r (;) ;(."'- '-'\ ..- (... ---'
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