78
Date Received:
Christine Fulton . ~
Jessica Fulton ~
~/ 1/:1
.1i-
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
IDGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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FOIL Ser. #:
FOR DEPARTMENT USE ONLY
Date Received by Dept /
Department Head ~~e~VED
/
(ini t)
Date Applicant Con~te!:4 20~ / _ / _
Date FOIL ful~~~~r-/ _
Closed by: 1:f)
Date:
/
/
Notes:
Amount Due:
Name:
Address:
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (cg
Email address:
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~IC DESCRIPTION OF RECpRD: 6
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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
o 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