108FOR INTERNAL USE ONLY
Received by: Christine Fulton ^ ,
Jessica Fulton
Date Received: ~ /~ /
FOIL Ser. #: ~J
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 3 ~I~~ 5~2i9`S:sSSd
De artment Head approval~~` ~8-Pd~01
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Date Applicant Contacted:
$~ ~~~~-
Date FOIL fulfilled or denied:
Closed by:
Date:
Notes:
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4
~/ 3 /~
Amount Due: ~ Pages for a total of $
Name: Cti ~ ^ check here if you are
Address: - ( ~ ~ ~rdf D requesting that the records
~~ i ,,_~ ~' n~Y lZ~~~ be mailed to this address.
Agency or firm:
Telephone #: (~/-t'~ ZZ c(-~ZS~ FAX #: ( ) -
Email address:
SPECIFIC ESCRIPTION OFCORD:
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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