039
Received by:
Christine Fulton ""A
Jessica Fulton 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received: a f)~ / I ~
FOIL Ser. #: 031
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK ~
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 FO~ or denied: d If).t/! I 12
Closed by: @
Date: ;; /
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Notes:
Name: l
Address:
Amount Due:
Pages for a total' of $
Agency or firm:
Telephone #: (
Email address:
o check here if you are
requesting that the records
be mailed to this address.
FAX#: (
)--
SPECIFIC DESCRIPTION OF RECORD:.--r' f5 ~
~ /~, ~ ,
T~ /~;~/~ '
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