114FOR INTERNAL USE ONLY
Received by: Christine Fulton , ^/
Jessica F~~uiilton
Date Received: ~ / ~?S/
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING ~
PLANNING ^
ZONING ^
C 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
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Date Received by Dept _ / _ /
Department Head approval:
(mot)
Date Applicant'Confact~~`I~~ U~F,ICE /
~...,,x~8~ab~-,~h~oad
"°-~ Ealls, .Y.
Date FOIL fulfilleda~°~~~d. ~ 12590
Closed by:
Date:
/ /
Notes:
Amount Due: Pages for a total of $ .
Name: 1 ~i 4-<.c ^ check here if you are
Address: ~ v ~ requesting that the records
~ _ 1 ~ , 1`l ~ I ~ Z ~3 ~ be mailed to this address.
Agency or firm: '
Telephone #: (~ys) L) ~ -~._Z FAX #: ( ) -
Email .address:
SPECIFIC DESCRIPTION OF RECORD:
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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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above