050
Received by:
Christine Fulton " ~/
Jessica Fulton y
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER ~
TOWN ATTORNEY 0
Date Received: Y];, /1- / 12-
FOIL Ser. #: 0,50
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / ~ / I L
Department Head approval:
(init)
Date Applicant Contacted: ~ / ~ / \ L
Date FOI~ denied: ~ / ~ / \ 2..
Closed by: ~
.2/ ~/ /2-
Date:
Notes:
Pages for a total of $
Amount Due:
Name: Jq~ c... I\l\~At::rt:
Address: 2.& ,,^.a(1.~\JI.L')QOi) ~
Agency or finn:~~,:'~;:1 \'1..S90
Telephone #: (84-~) '5"0'5 - o~77 FAX #: ( )_-
Email address:JAne..C.aI\6ftOb ~ IJ ElZ-r=l:O~ . ,..h.,..
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
"'Z.D ~lJnr..h \'\J11. Q~ -At)1)n\~ ~~~,
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