131
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica~~F//ulton
Date Received: ~ I ~Pj / ~~
FOIL Ser. #; ,__~__~_
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ^
/
PLANNING G
ZONING [~
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK 0
WATER/SEWER ^
DOG CONTROL OFFICER C!
TOWN ENGINEER ^
TOWN ATTORNEY 0
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: ~(; ~r~l ~ 1"'~..f-~- ~•r' ~.a_ t.~t2L C--,n~.~, i~ ^ check here if you are
Address: g5 Ctvtic. Cgnk.r tom- cxzt+~ , Su; ~ 1 v3 requesting that the records
~''t' ~s 2 ~. be mailed to this address.
Agency or firm:~,~ L-t,~u•?
Telephone #: (e~cS) a43 - aFs~ FAX #: { ~~ a(v.s- ~S) ~S
Email address: ~~_~~-~,_(~ ~r ~e.o~r~,_~{_,_~,~ __
SPECIFIC DESCRIPTION OF RECORD:
~~tA\ ~tu~.~-u.'t;o~n ~x a~ Sl~•erP-}~. e,~~',F;ct~t.1~
ca.•~>~ecl s; ~ ~' scan .~'c~r' ;~r,~~ 1 u cc~.~ ~-4~ : ~ sk- I (p c~
~v.~Ys ~Yne>~ i2t~~ ~ '~;T___c:.~ -~~ -~- ~as~~- r33 -3~3a~fa
FORMAT OF RECORD (if available)
I request to be notified when I can come to inspect the record(s) described above
C~ 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 (-c~e„ ~•.cc~- ~Ic.~ s~-1-~~
I request that the records be sent via a-mail to the address listed above (~ ~/ax ~ t dvc~-mc~-ts~
^ I request that the records be faxed to the number listed above