11FOR INTERNAL USE ONLY
Received by: Christine Fulton w^
Jessica Fulton C~
Date Received: ~ / ~~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK C~
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 Head approval:
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: / /
Closed by:
Date: / /
Notes:
Amount Due: Pages for a total of $
Name: J"~%~5 ~ re~ S~ ~ v/~C v 5/-l. ' ^ check here if you are
Address: 3 2 -C, ~ ~~ ,.L,. ~~ requesting that the records
Cl..~/SPA ~/% X23 % Z be mailed to this address.
Agency or firm:
Telephone #: (~ji'~) 7aZ - 3~7 FAX #: ( ) -
Email address: rl S r'y /~ ~ 20 / ~ ~o ,~
SPECIFIC DESCRIPTION OF RECORD:
~X A i ~a..'lF I vu~ o ~ Cc ~ ~i°, ril S ~rv~~ ~c~,.J ~.ruL~- cJ ~ o~ ~/ e,
jt~ ~,O r .~f 2/~'
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