063
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Christine Fulton M
Jessica Fulton 0
Date Received: 04 / /0 / I?.
FOIL Ser. #: 0 UfJ
Received by:
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DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES il
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: !:L ;/ U / I~
Date FOIL fulfilled or denied:
/
/
Closed by:
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Date:
/
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Notes:
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Name: ~
Address: ~ ~ ~""se ~"".~
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Agency or firm: ~~
Telephone#: (<?fr)~ - /9f:r FAX#: (
. Em~lfl.ddress:
Amount Due: ~ Pages for a total of $ 13 6
o check here if you are
requesting that the records
be mailed to this address.
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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
~ 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