057
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by:
Christine Fulton D
Jessica Fulton 8
Date Received: g / g]/ ~
FOIL Ser. #: OS '7
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT P:;
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
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(init)
Date Applicant Contacted: .3 / d.i / ~
Date F~enied: 3 / Z-~ / -'L
Closed by: tA{ 6--
Date Received by Dept
Department Head approval:
Date:
~ / ~/ ...L.L-
Notes:
Amount Due:
Pages for a total of $
Name: :JOhf'\ ~k".M V"Jo.lda
Address: '22 M()1l ~ '.s Wo.~
Po k. p,J"Y 12~oI
Agency or firm: Se( t
Telephone #: (84S ) 452. - ~42.
Email address: oht\ V h ~ .
D check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD:
- c.oplU of" Q l\ C.e.r-h~ll:a+e. nr
- Co~ o~ \-\ouse... rlof\S.
Occupa t\ L~
"Too" M V,vo\da.
20 SHA~ DR
W P. ~A LS IVy
12601
FORMAT OF RECORD (if available)
D 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
r:J I request that the records be sent via e-mail to the address listed above
D I request that the records be faxed to the number listed above