087
Received by:
Christine Fulton ~
Jessica Fulton 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
QI 21 12-
CJl
/ ~ WAF> -.
. .,.~. . '" .~().._ ..". .~.J:'l+'...." ..'
~.JJ ' ;..' Q~
0' ,....:.
ill- ( - , ,~\\
O\~-- . '>1
C\ '~!
...." .. '
_ (\ . _ ,t' -':'
-s-('<~--,.:/ ~A.i
,,s_5 cOV '
FOIL Ser. #:
DEPARTMENT:
ASSESSOR D
ACCOUNTING D
CODE ENFORCEMENT D
PLANNING D
ZONING D
FIRE INSPECTOR D
HIGHWAY D
RECEIVER OF TAXES D
RECREATION D
SUPERVISOR D
TOWN CLERK ~
WATER/SEWER D
DOG CONTROL OFFICER D
TOWN ENGINEER D
TOWN ATTORNEY D
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ I (Ii; rd-
Department Head approval:
(init )
Date Applicant Contacted: ~ 1 l 1 I~
Date FOIL fulfilled or denied:
Closed by:
Date: tLI 21 j~'-
Notes:(~~_
Amount Due:
Pages for a total of $
Name: \Cob w~\ \ <3:,0"
Address: 15 '(O)\dctWa..L"bh.
AgenCYOrfirm:~c.om~
Telephone #: ( )SC/7 - &'(S.. FAX #: ( )_-
Email address:
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: _ n
~\<cl ""t:x:L~~ ..!be ~LLenqu----;-i.ucJ,
o
FORMAT OF RECORD (if available)
I request to be notified when I can come t~he record(s) described above
I request copies of the records described a~ee 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
o
o
