072
Received by:
Christine Fulton 2
Jessica Fulton -~
5 lor I ]2
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
FOIL Ser. #:
WAPI)
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING ~J
CODE ENFORCEMENT ~
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
Date Received by Dept
Department Head approval:
FOR DEPARTMENT USE ONLY
5'11 I/~
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Date Applicant Contacted: 6 I L I I ,1..
Date FOl~ or denied: S-I ~ I I a
Closed by: II 0-
Date: 5'; L I 12
Notes:
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Amount Due: Pages for a total of$
Name: ~, \, f ~Q...Cj\ - ~ ~ OS ~'II .
Address: C. \0 ". ~'-l,S :L~ -
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Agency or firm: ~~ S
Telephone #: (o..\~ ) ~-'l \'t:$ FAX #: ( ) -
Emailaddress: ~~"S~~qS~~ . r_~
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: ~ I
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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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