129FOR INTERNAL USE ONLY
Received by: Christine Fulton ~i
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: G~i~~ P~~L' <1C~~~ ~-CJ ^ check here if you are
Address: /~ c9 F~'PT /~ '~ ~ requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (~' ~~) 3 FAX #: ( ) -
Email address: tci ~ C~ ~ 9 S' ~ ~~i ~o e ~ ~'0~
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