071
Date Received:
Christine Fulton . 0 ./
Jessica Fulton ~
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
FOIL Ser. #:
WAP,:.
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DEPARTMENT:
ASSESSOR D
ACCOUNTING D
CODE ENFORCEMENT -g'
PLANNING D
ZONING D
FIRE INSPECTOR D
HIGHWAY D
RECEIVER OF TAXES D
RECREATION D
SUPERVISOR D
TOWN CLERK D
WATER/SEWER D
DOG CONTROL OFFICER D
TOWN ENGINEER D
TOWN ATTORNEY D
FOR DEPARTMENT USE ONLY
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Date Applicant Contacted: !L 1221 /2-
DateF~enied: 1-/~t) 1 /7.-
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Pages for a total of $
Date Received by Dept
Department Head approval:
Date:
Notes:
Amount Due:
Name: cre JL)
Address: d 7 j;'J'1'L. ~ , p/'.
'P~~f~ NY IUo3
Agency or firm:
Telephone#: (Wr-) tjt.'3 -561& FAX#: ( )_-
Email address: c1-ro~ Iro/J' ~,
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: 1'1
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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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