127FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton ~/
Date Received: 8 / 1 ~l /~!~
FOIL Ser. #: ~~
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECENER OF TAXES ^
RECREATION ^
BUPERYISOR ^
TOWN CLERK ^
'w ATER/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:
r'
Date: i ` ~ l 1 ~ l ~'c~-
Notes: ~U ~ ~~
Amount Due: Pages for a total of $
Name: S'~c.c~ ~~' ,~ ^ check here if you are
Address: ~-,~) ~~~ l,~,e.. requesting that the records
/~ r' ~ Q r c ~ ~ F ~- j'~ ~ ~ (c~ y be mailed to this address.
Agency or fum: /1 I~ vex Le e~d.~ ~?~ .
Telephone #: (C~ / D(O - ~5'C,/FAX #: , ( 1 _
___ _Email address: _ _ 1l/ 5-_ - k~ s C[ o /. G~_
SPECIFIC DESCRII'TION OF RECORD: 1 p
.,
-- - -
- _ ___
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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above