051
Received by:
Christine Fulton 'I
Jessica Fulton 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONL Y
FOIL Ser. #:
-3 //3 / Jd
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051
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT A
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:
/ /
Closed by:
/
Date FOIL fulfilled or denied:
Date:
Notes: ILV)f e.IJJ~.J) /J10 ~/iu'J
Amount Due: Pages for a total of $
Name: b~ It 0 check here if you are
Address: <::. ,.J A-l, l +- requesting that the records
fA I Aft. -:ffYl1) I pJ be mailed to this address.
Agency or firm: G'" ~ AI { ~ LA ~ e. 12-
Telephone#: (g'-l5 ) ,297 - 3J.S~ FAX#: (gtf5 ).2!ZL- /1)0 ~
Email address:Pr//6-Jfl~Of-t<f.-\I.Ne....Je.J
SPECIFIC DESCRIPTION OF RECORD:
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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