962009-10-16 JCM
FOR INTERNAL USE ONLY
Received by: Christine Fulton ,~
Jessica Fulton ^
Date Received: ~~vr~ l ~~
FOIL Ser. #: ~ ~LP
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING
ZONING
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ~
l~'
RECREATION ^
SUPERVISOR 0
TOWN CLERK ^ j
WATER/SEWER ~
DOG -6'
OWN ENG
TOWN ATTORNEY ^
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
~~a ° ~ .~ ~
FOR DEPARTMENT USE ONLY
Date Received by Dept ,_ / _ / _
Deparkment Head approval: .
(init)
Date Applicant Contacted:
Date FOIL fulfilled or denied:
Closed by:
1 /
/ /
Date: ~/ 7%'/~~-'
Notes: /~D ~DC~K 5C'e`~er ~ ~ 1.~~`Y
Amount Due: Pages for a total of $
Name: ~ iS ~~'U~2b i r -' ^ check here if you are
Address: a o2 requesting that the records
d be mailed to this address.
Agency or firm: JU.p Q SOe~1 ~7 C ~~6,~,
Telephone #: ( ~ ~() /~ ~3 FAX #: (~~ ~) 77-
Email address: ~ 1~tJ o ~ ~ ~ ~'.n-~
SPECIFIC DESCRIPTION OF RECORD:
S~S/v- P3/T-~ le dd'' C-,~'JGr~ ~ awl ~
v/ '~Yz OFD
FORMAT OF RECORD (if available)
L7 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 a-mail to the address listed above
0 I request that the records be faxed to the number listed above