109FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton ^
Date Received: ~ / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR /~
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION 0
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 Held approval:
(init)
Date Applicant Contact~ed~:~° F _ [/~_ /
Date FOIL fulfilled or HIV E~ / _ /
JUL 0 3 2012
Closed by:
Date: TASSE o t?R,S (~FFIC-~
Notes:
Amount Due: Pages for a total of $ 1 ~ (~
Name: a e~~ ~ e M . Vo n IBura - ~ri e~m an ^ check here if you are
Address: ~Z ~~ri 11o ~~'ee, requesting that the records
~(F ~1`f 125q O be mailed to this address.
Agency or firm: ~ ~ R
Telephone #: ($~IS 2`I ~ - I q(~ 8 FAX #: ( ) -
Email address: li ~ n ~ ~ ~lE.}-
SPECIFIC
CRIP~ON OF RECORD:
r"
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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above