052
FOR INTERNAL USE ONLY
Received by:
Christine Fulton 0
Jessica Fulton 0
Date Received: l / J:i / [9-
FOIL Ser. #: ~
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT ~
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREA nON 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept -.3 / I t{/ I L
Department Head approval:
(init)
Date Applicant Contacted: --.3.. / -LCf -.ff-
Date FOe denied: ;il J.!J / L
Closed by: ~V
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Amount Due:
Name: '1' Av L. f' ~ I-o~ I 12. k 0 check here if you are
Address: J-f 0 \L.IsrJt ~ requesting that the records
~p ~~ rv'1 I U'l 0 be mailed to this address.
Agencyorfirm: ~.J. _ ~ _G.~
Telephone #: (Sl{:) ) ~- 01 ,,~ FAX #: (!N~ ) tqo _ 12..t'-f
Email address:
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
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I request to be notified when I can come to inspect the record(s) described above
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
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above
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