065
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REOUEST
Received by: Christine Fulton 0
Jessica Fulton 0
Date Received: -=L/~/~
FOIL Ser. #: eft
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DEPARTMENT:
ASSESSOR )?f
ACCO~G 0
CODE ENFORCEMENT 0
PLANNING 0
ZONrnNG 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
Department Head approval:
I I
(init)
RECEIVED
Date Applicant Contacted: I I
APR 3 1 2012 - -
Date FOIL fulfilled or denied: I I
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Closed by: -, ," .'~ 17'.i'!!'l1J~ ~
Date: I I
Notes: ~
Amount Due: Pages for a total of $/, 00
Name: !lalnl lJi/ie fro 0 check here if you are
Address: va/ f!IJ -Ii/) ~ d f /Vl. requesting that the records
WCtP'pI'rJtJg./T AJV /1J'?9{) be mailed to this address.
Agency or fmn: II erilaqi ........t"ea 111./ 6'/tJujJ
Telephone #: ( ) ~- FAX #: (9/<1 ) 7g~ - jilt! 3
Email address: rn s b amandtL A aJ/ (' t1/Y1
SPECIFIC DESCRIPTION OF RECORD:
{'~.Py tJ~ d eeol 0/1 a II 1./ f)!1rC'"el s (va/en fiN dr) ;lar If! d/fltelro
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
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