110FOR INTERNAL USE ONLY
Received by: Christine Fulton 0/
Jessica Fulton
Date Received: ~ / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER 0
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 `~ / 9 / t ~
Department Head approval: .
(init)
Date Applicant Contacted: ~ / ~ /
Date FO fulfilled denied: ~ / ~/ /~
Closed by: /~ ~y --
Date: ~/ ~ //
Notes:
Amount Due: Pages for a total of $
Name: N~ L~ /i`z ~ ~ //~ ^ check here if you are
Address: L,~1 i ~ v~ ~~/ requesting that the records
t/n.~~~,~ ~~.1/s ~c/',~ be mailed to this address.
Agency or firm:
Telephone #: (~ l zi) ~~- UU FAX #: ( ) -
Email address: /nU/ >~h a~s~ /-ti.e.L w~n ~'va / ~ ~a~.~a, ~y,,,,`
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
'~
SPECIFIC DESCRIPTION OF RECORD:
~. f /f'I ~l~ 4 C~rn~,r t ~~ 1.~nE0/Ji-/~a r~'I ~.a~~s of ~/