92FOR INTERNAL USE ONLY
Received by: Christine Fulton ~
Jessica Fulton ^
Date Received: ~ / ~ / ~~
FOIL Ser. #: ~ ~ ~-
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
PLANNING
ZONING
FIRE INSPECTOR ^
^
HIGHWAY
_
RECEIVER OF TAXES L~'
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^ /
WATER/SEWER
DOG CONTROL OFFICER
^
,
,/
TOWN ENGINEER L'7
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept _ / _ / _
Department Head approval:
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: /
Closed by:
Date: ~ / ~~ / ~ ~
Notes: /,,Q,[,r1..[~Q ~ ~~
Amount
Name: ~ i s ,~l'U ~t_~ r ~ ,' ^ check here if you are
Address: ~ 02 requesting that the records
d be mailed to this address.
Agency or firm: JU,p Q Sde~1 /~~~~C
Telephone #: ( [ Y) [Z- /3 FAX #: (~~ ~') 77- ~~~~
Email address: ~ I'cJ d ~ ~ ~ ~ Co'y,~
SPECIFIC DESCRIPTION OF RECORD:
T,4 ~G~~ . A~SC~SrYr ~/T~
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FORMAT OF RECORD (if available)
[S 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