97FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ / ~ /1~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
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: ~ 2 J~
Date: --~/~/~
Notes:
Amount Due: ~ Pages for a total of $ ~_ ~~
Name: L ~rZr~ ko t /Qrtc~ ^ check here if you are
Address: _ ~fy Lt1 ~ !off u/o-~a/ rl~a~ requesting that the records
~"~ ~(~,~,,~ rc/ S/ 27 7 7 be mailed to this address.
Agency or firm: ~ or~aP ~ r ~ r
Telephone #: (F d') 7 4 ~ - / ~ 70 FAX #: (rya') 7 9 / - !o ~ G
Email address: -'~ ~ ~~ ~ ~~~. - T/- w ~
SPECIFIC DESCRIPTION Ok' RECORD:
~G~
3 7 s~ ~ /v t,~G G I s r
~ a, f =
FORMAT OF RECORD (if available)
^ 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
^ I request that the records be faxed to the number listed above