11107/1612012 12:36 845743670@ A COPY A SECOND PAGE 02
FOR INTERNAL USE ONLY
Received by: Christine Fulton _ [J .
Jessica Fulton
Date Received: ~ ~ ~~
FOIL Ser. #: _.~.~.~
DEPA,R'I'MENT:
ASSESSOR ^
ACCOUNTING 0
CODE ENFORCEMENT ^
PLANNING ^
zoNEVG ~
FIRE EYSPECTOR ^
I-IIGHWAY 0
RECEIVER OF TAXES ^
RECREATION 0
SUPERV150R
TOWN CLERK
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application far Public Access to Records
FDIL REQUEST
FOR DEPARTMENT USE ONLY
Datt Received by Dept ~ ~ / r ~ / ` ~'
Department Head approval:
(init)
Date Applicant Contacted; ~ / 1 ~ / 1 ~
Date k'OI lftlled r denied: /
Closed by: C
Date: n '~1 / ~ ~ / ~~
Notes: ~Y\C,I~J~O f ~~~ -
AIYIOUnt Dl1C: /gapes t'Or a tOtAl Of $
Name: f C d A f (.t; d U check here if you are
Address: i • requesting that the records
OK . A1.Y~ ~.~03 be mailed to tbas address.
Agency or firm: --
Telephone #: (8 ~{~S ) -~-~~ FAX #: ( ) - ~.dCsU~
Ez~aail address: .._ N i ~ ~_.~.r~ ~ ~E ~ ~A Noo• CoM ~~ ~ • L~Dr~UC'
SFFCIFIC DES RIPTION OF RECORb:
}{ } r ,n an ~o '~'D 0 o V~~!
h ank~ u
i~0.S ~- 2.YY'1 di ~afS~ , 1
~ fax $ 5 -'-4S ~+ - ~
FORZvI.AT Off' RECORD (if available}
U' l request to be nati~ed 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 sched~rle on the back. of tk~is application.
I request that floe records be sent via a-mail to the address listed above
U I request that the records be faxed to the nuz~nber listed shave
07/10/2012 12:36 8457430700 A COPY A SECOND PAGE 03
20Q9-YO-16 JCM
The Town of Wappinger has designated the Town Clerk, by the adoption of Resolution N0. d3 of 2002, as the Rtcards
ManagemeHt Officer (RMO). It is the r+espanstbility of the RMQ to ensure compliance with the FreedmrH of Init)rnlation law.
The Tawn Clerk's Office houses many of the Town's records and maintains a subject file Inakx cM choir record:. Mawever', each
individual Oepartrnrnt within the Tawn of Wappin0er govsrnmer>t maintains retards specttk to their affks and is designated
custodian of such records.
Active retards are located at the Tawn Hall, 20 Middiebush Road, Wappin:ers Falls, NY, 125e0. Flours of operation far the
Town Nall are 13;30 AM to 4:00 PM, Monday through Friday, excludin: holidayx named at each Reorganization Meetin; and other
times during which the Town Supervisor, or other authori=e~d afficiai, directs the Town Halt to be closed, such as for inclement
weather or other emer~sncy.
Fbti, request farms are available at the Town Clerk's Office- To make a request for access to records, fill out the
application to include the follawing:
• Name
• Agency or Firm (write "self" if making the request for yourself)
• Address of apptkani
+ Telephone number of applicant
• Fax number of applicant
• Notate if you would like copies of the records or would only like to inspect the records
• A SPECIFIC description of the records brine requested
FOIL requests can be faxed, emailed, mailed or dropped off at the Town Clerk's Office. If mecords are bring requested
from multiple offices, submit separate requests far each.
The tort for copies of records is 50.25 per pair for paper copies up to 9" X i~". Capiss for most other records wilt be the
cost of repmductian. Other costs will be calculated in accordance with lii37 of the Freedom of Information Law.
Upon receipt of a FOIL request, the RMO wilt tassi~r the request a serial number. The request will thin be entered into a
database and forwarded to the appropriate department. Within 5 days After the receipt of the request, the responsible department
will make such record available to tlx parson requesting it, deny such request In writing or furnish a written acknowledgment of the
receipt of such request and a statement of the approximate date, which shad tae reasonable under ehs circumstances of the request,
when such request will be granted or denied. The'riippiroximatc date will bs within 20 days of the data of receipt. If the request
cannot be fulfilled within 20 days, the department wiil,provide the raquastor with an exact daft that the record will, wholly or in
part, be provided or made available. '
The RMO may require the requestor of certbn FOIL requests to Sign an affidavit that information being provided will not be
used for solicitation orfund-raisin; purposes and thit the requester wilt not sell, give ar otherwise make such information available
to another person for the purpose of allowing that persaH to use the information f01' solicitation or fund-raising purposes.
A requester may ask that the town Clerk Certify records being requested. Such requests will require that the requester pay
the appropriate fee for certified copies as set forth in .Chapter 122 of the Town Code of the Tawn of Wappinger.
If a request is danced by the RMO or appropriate custodian, the requester may appeal such denial w1thlH seven business
days of receipt of denial. Appeals must be submitted in writing and sent to the RMO.
The information provided here is posted to assist you with your FOIL request. It will be updated as Herded, but is always to
be considered subordinate to the Freedom of Information Law and the Town Code of the Town of Wappingsr. if at any time, the
infarmatian pasted here contradicts the Freedom of Information Law ar the Tawn Code of the town of Wappinger, the information
pasted here is tb be deemed invalid.
itecord of Attempts to Contact Appiicapt
For Internal iJge On
StsPf Member Phoae Namber Called L-mall Address ii a bla Ante Mersa a Left /t~i
~',:
'Notes & Comments
07/10/2012 12:36 8457430700 A COPY A SECOND PAGE 01
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790 Main Street
Poclghk~epsie, NY 12803
F~hor~e; 845-471-51G9
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PLEASE l~,O'~!?: 1F YQU ARE R~RNING A
~~ax - p ~Naic~-rE.~~RSalws nt,~ME ~
PHUNI= NUMBER. Thank You.
bate:
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