086
FOR INTERNAL USE ONLY
Received by: Christine Fulton 0
Jessica Fulton ;g{
Date Received: (2 I ~ I /~
FOIL Ser. #: ?5 (;;;
DEPARTMENT:
ASSESSOR D
ACCOUNTING D
CODE ENFORCEMENT .%
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
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
/~/7 112-
-VL -q tY
(init)
Date Applicant Contacted: iL I ~ I LL
DateFO~~nied: ~I Ol-.LL.-
Closed by: N 6-
Date Received by Dept
Department Head approval:
Date:
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Notes:
Amount Due:
Pages for a total of $
Name: &e/~ ~/J~~~ /~~
Address: ~ ~ J_
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Agency or fIrm:
Telephone #: (f'frJ liL- '2 z, If FAX #: (
Email address:
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o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
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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