95FOR INTERNAL USE ONLY
Received by: Christine Fulton i~,
Jessica Fulton ^
Date Received: ~L~/ L ~ /~
FOIL Ser. #: ~~~
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR ^
HIGHWAY 0
RECEIVER OF TAXES _
I~'
RECREATION ^
SUPERVISOR ^
DOG CONTROL OFFICER ^
TOWN ENGINEER
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:
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Notes: (~ uk~Q~.S~ ~r j--+ n eS
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Amount Due: Pages for a total of $
Name: ~ is ~Y(/~t.~ ~i r .' ^ check here if you are
Address: ~ 02 requesting that the records
d be mailed to this address.
Agency or firm: J~.p Q{~Sda~l 12~1~C
Telephone #: ( <<-() /L- %353 FAX #: (~t~') 77- ~~~~
Email address: ~ l'cJNio ~~ .' ~ ~ , Ca'y~
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
J" 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