040
FOR INTERNAL USE ONL Y
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by:
Christine Fulton 0
Jessica Fulton c&'
Date Received: ~ /!lL / $
FOIL Ser. #: ~LD
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT g
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 ;.. / ~ tf/ I J
Department Head approval:
(init)
Date Applicant Contacted: ~ / g. <( / I;'
Date FOIL fulfilled or denied: g....;0l t(; I L
Aft;)
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Notes: t~
Closed by:
Date:
Amount Due:
Pages for a total of $
Name: '-\,~~\~\\
Address: I J ~~\ C -4-
n=:;i'\~~! Ja584
Agency or firm:
Telephone #: (8'15) ~C(f 1..{~ FAX #: ( ) -
Email address: ('\ 1,0C:.::> r)~ +
o check here if you are
requesting that the records
be mailed to this address.
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