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94~y~k.~
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FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton 0
Date Received: ~ / 1 ~ /
FOIL Ser. #: 0~`T
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING /
ZONING 0'"
FIRE INSPECTOR ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK D /
WATER/SEWER ~
DOG CONTROL OFFICER ^
TOWN ENGINEER C~
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL 1~EQ VEST
_~ ~ ~
FOR DEPARTMENT USE ONLY
Date Received by Dept / _ /
Department Head approval: .
(inif)
Date Applicant Contacted: _ / - /
Date FOIL fulfilled or denied: / /
Closed by:
Date: '~ / ~ / ~ Z"
Notes:
Amount Due: Pages for a total of $
Name: ~ i~ .~rU~2.b i ~ ~ ^ check here if you are
Address: ~ 02 requesting that the records
d be mailed to this address.
Agency or firm:.j(1 0 SDe~) L 7 C ~~6,~,
Telephone #: ( ~ ~() l~ f3 FAX #: (~~ ~) 77 -
Email address: e rv o ~ ~ ~ ' , Cdy,. ~
SPECIFIC DESCRIl'TION OF RECORD:
~,4 ~D~~ ~kSe~Slvr ~1
C /--~Jc~ ~ a~/~
FO/RMAT OF RECORD (if available)
L7 I request to be notified when I can come .to inspect the record(s) described .above
1~- 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 a-mail to the. address listed above
0 I request that the records be faxed to the number listed above
