116 (2)FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~/ ~ / _ r~
FOIL Ser. #: / /~
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
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
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / ~ ~ / j ~
Department Head approval:
(init)
Date Applicant Contacted: ~/ ~ ~ / / ,~
Date FOIL fulfilled or denied: / /
Closed by:
Date:
Notes:
~/~ /~~
Amount Due: Pages for a total of $
Name: ~~ ~ ~ ^ check here if you are
Address: \ ~ ~- ~ requesting that the records
\ ~ 'S~ be mailed to this address.
Agency or firm: G~ ~ Q 9`91 C~ 4--F ~ . '
Telephone #: (~9 ~) Z°~~- ~ C~ FAX #: (gyp S) ~~ - cam' ~3 -~ ~ ~
Email address: C`~x`c\_« ., S~(lc.a c~?~C~'t7S--~ ~ ~~ ~~ ~ -tea
SPECIFIC DESCRIPTION OF RECORD:
~Q
G • b `~ ~ o
C,
~ "D
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