982009-10-16 JCM
FOR. INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ /~ / / a-
FOIL Ser. #: _ i!
DEPARTMENT:
ASSESSOR l.)
ACCOUNTING f
CODE ENFORCEMENT ^
PLANNING ,~
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
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: _ / _ I
Date FOIL fulfilled or denied: /
Closed by:
Date: ~ l~Jrl / ~
Notes:
Amount Due: Pages for a total of $
Name: ~ ~ R ~ lJ^I - ~' ~ ~ WS lK-. ^! check here if you are
Address: ~ ~ p ~- ~ requesting that the records
W ~ rv y be mailed to this address.
Agency or firm: ~sl~
Telephone #: (~y,~ 7~Z-_~ FAX #: ( ) -
Email address: ~. ~~ / ~ neTr.v 0, .~Y . ,v..-~f
SPECIFIC DESCRIPTION OF RECORD:
V nJ ~ ~ t 1'~ G o 't'G ~l ~ ~
Z`A
~ORMAT OF RECORD (if available)
Gill G~~elu R~p~(y
_ 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