100FOR 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 •^
R
DOG CONTROL OFFICE
^
TOWN ENGINEER _ _ ^
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF ~VAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept (c? /~ ~ / /~
Department Head•approval:
(init)
Date Applicant Contacted: ~ / ~/ / ~
Date FOI ille or denied: In / ~'~/ / ~
Closed by: ~~
~~:: ~ _.
Date:: ~ ~ / ~ ~/ / L
~! Notes:
Amount Due: Pages fora total of $
Name: '1~~- A~~~~IU .~'cheok here if you are
Address: ~~1U\ ~ov`~E ~~ K 30~ Sc'}~ requesting that the records
~~~~;\~E ~~( lOgiS' be mailed to this address.
Agency or firm: o -~NC~
Telephone #: (~1S) 3~~ - ~1~3 FAX #: ( ) -
' Email address: ^" (~ i - TRi 5 i (~~ fs ~\.~ ~ L~ t~
SPECIF~C DESCRIPTION OF RECORD:
+2cm~~ S.~t'c~tnAP.~ ~d~ !~'JA•y A~ ~VnC ~- ~ 12-
''For jVQW Gor\5\RXi~ti~c,1 c~t~. I}D D~ ~; o NS ~U 'aAM~S
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