054
FOR INTERNAL USE ONLY
Received by:
Christine Fulton ~
Jessica Fulton ~
Date Received: 13... / J.:L / ~
FOIL Ser. #: ~ 5'-{
DEPARTMENT:
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ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING ff
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 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
DepartmentHead approval:
/ /
Date Applicant Contacted:
(init)
/ /
Date FOIL fulfilled or denied: / /
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Closed by:
Date:
Amount Due:
Pages for a total of $
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Name: I,OBn r T ~ ICaN\S'
Address: 10 R I~~ ~ 41 (::>
Agency or firm: I~ - a AP PIt'A-( ~ l '
Telephone #: 03c.t'S) 227 - cq~!t FAX #: (
Email address: ~ p~ (!) ~ 7OI\J "" N O'../\.'-'
o check here if you are
requesting that the records
be mailed to this address.
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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