130FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ / ~ /
FOIL Ser. #: O
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ®'
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR U
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 FOI lfilled r denied: ~ / ~/ / a~
Closed by:
~~
Date: ~~~ / %~ / ~~
Notes: t~ ~- ~'
Amount Due: Pages for a total of $
Name: ~- N /t-o. ^ check here if you are
Address: G.~ r requesting that the records
u v..~.ii , ~,, /.~~ ~C1 be mailed to this address.
Agency or firm:
Telephone #: ( ) -~L~f FAX #: ( ) ~~_
Email address:
SPECIF ESCRIP ION OF CORD: _ ,
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