059
Received by:
Christine Fulton 0
Jessica Fulton X
..!:LI 3-1 ~
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Sera #:
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~~
CODE ENFORCEMENT -c::t::lS.
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 .1- / 3 1 I 2-
Department Head approval: ~
(init)
Date Applicant Contacted: i / :L. 1 / Z-
Date FOIL fulfilled ~5/L 1/2-
C sed by: I{.~
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Notes:
Name: '"Do.."'~e.. \ ":3'. lX-'\oS
Address: t:) '-'-', \o.\J.:)OC>~ 'CTV-("l: "l ~ \2.. c...
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Agency or frrm: C I Gv~("" t' e~-k.~\o<'" 5
Telephone #: ('(r...{'t-) .;1-"", - oute- FAX #: ( )_-
Email address: do.'('\t9c..:~.u-'-'H-er. C~
r!(check here if you are
requesting that the records
be mailed to this 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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