128FOR 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:
l ~l ~ Z-
~imt~
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied: ~/ ~ / lZ
Closed by:
Date: ~ ~ ~ / ~ / ~ ~
_„ _ „ .
Notes:
Amount Due:
for a total of $
Name: !~~ ~ ~-T ~Y'/~-u~~` ^ check here if you are
Address: ~ 3 ~' ~-~ requesting that the records
~ ~~- be mailed to this address.
Agency or firm:
Telephone #: (~(j) - 77 FAX #: ( ) -
Email address:
SPECIFIC DESCRIPTION OF RECORD:
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