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FOR 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 ^ 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: ~ r ~ q -/~ C) ' ~(} h ~ ~ ^ check here if you are Address: ~~ m ~-- 'C ~ requesting that the records F~ ~ '^'~. ~ 215 be mailed to this address. Agency or firm: Telephone #: (~~) 3~ -_ 2Q 5 aS FAX #: ( ) - Email address: C7v 1G4~ ~ ~ o ~cl ~ ~ a~llo© •co +m , SPECIFIC DESCRIPTION OF RECORD: 1-t Cc~ i( ' c~ ~ S ~ ~~ ~ 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