123FOR INTERNAL USE ONLY
Received by: Christine Fulton ^ ,
Jessica Fulton
Date Received: ~ / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^ l
CODE ENFORCEMENT
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES Q, _
_
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 (/~ / / /.2.
Department Head approval: ~C
(knit)
Date Applicant Contacted: ~ / ~ ~ / / aZ
-:Date FOIL fulfilled or denied: ~ /~ / ~ -
Closed by: _. /~ :~
-Date: ~~/~/ ! 02--
Notes:.
Amount Due: Pages fora total of $` '
Name: C ~ ~L ~G~ ~ l.~(1- ^ check here if you are
Address: / )r~ ORS~S~ia~- 6„Jq requesting that the records
~ ~ L~/,,~a~ ~ R ,,~~ ~ ~ S"~"'3 be mailed to this address.
Agency or firm:
Telephone #: (q) ~1) ~17i/- ~5~3 FAX #: ( ) -
Email address:
SPECIFIC DESCRIPTION OF RECORll:
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3~ D ~ {rte
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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 a-mail to the address listed above
^ I request that the records be faxed to the number listed above