132,~--~ l~,~t.
FOR 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 0
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 ~ y l a ~ / ~ ~''
Department Head approval: ~~f}'
(init)
Date Applicant Contacted: ~ 1 / 2~ / ~ `L
Date FOIL fulfilled or denied: ~~ / ~~ / ~ ~'
Closed by:
Date:
Notes:
Amount Due:
Pages for a total of $
Name: ~~ ~ ~~k~ /+n Se ~ v~-, ^ check here if you are
Address: ~ ~ requesting that the records
be mailed to this address.
Agency or firm: ~- ~ '
Telephone #: (3 i q) 8 (0l - 54 t~3 FAX #: (~ ~ q) S(o 1 - 5 5 °p
Email address: ~; !r ~ ~ . /-~--~, ~ -~ t ,..., (~ ,.,r,. ~ ~ , .~-t- ~ o ~ a _ . _ _ r_ _ _ _
SPECIFIC DESC
FYG l 2 /~ /~ PTION OF
Zo// CORD:
~, al,~~c ~ ~ir~~ ~` / ~~~?~-~
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
/ /