116FOR 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 ^
SUPERVISOR ^
TOWN CLERK 0
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 ~ /~~' l ~-
Department Head approval: ~~
(init)
Date Applicant Contacted: ~ / Z~/
Date F L fulfille denied: / /
Closed by:
Date: ~ / Z.o /
Notes:
Amount Due: Pages for a total of $
Name: ~~ ~ ~ ^ check here if you are
Address: ~ c~ l requesting that the records
\ ~(1 ~~ be mailed to this address.
Agency or firm: G~ ~ Q ~~~ ~ ~~
Telephone #: (~-f S) Z9~-- ~-F"lc~ FAX #: (~-pS) ~~-- ~~
Email address:~c «" ~flc~ c~~L~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