1252009-10-16 JCM
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FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: C~ / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING ^ ,
ZONING ~ -
FIRE INSPECTOR ^
HIGHWAY ^
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.RECEIVER OF TAXES ~
^ __
_
RECREATION _
^
SUPERVISOR ^ -`
TOWN CLERK - ^
WATERISEWER ^ -
DOG CONTROL OFFICER 0
- TOWN ENGINEER ^
TOWN-ATTORNEY ^ ~ _ -
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
..
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / / / ~ Z
Department Head approval:
(init)
Date Applicant Contacted: ~ / ~ / ~ L
Date FO i le .denied: '~ /t ~/ ~~
Closed liy: .. , .: ~;~
Date. : ~: - 2,
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Notes: / ~/
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Amount Due: Pages fdr a total of'$`'
Name: ~ il9~ ~ !7 ~ Q'check here if you are
'~ Address: ~ requesting that the records
~ ,, ~ be mailed to this address.
Agency or fum: P~
Telephone #: (~~~/~~) a~ - ~ /5' FAX #: ( ) -
Email address:
SPECIFIC DESCRyI,PTION 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
0 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