133FOR INTERNAL USE ONLY
Received by: Christine Fulton ~,
Jescsica Fulton ^
Date Received: 0 / ~l /ai
FOIL Ser. #: / .3j
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:
Date Applicant Contacted:
/~o/ /~
~_
(init)
/ .~~/ / a
Date FO lfille or denied: ~ / o~v/ /~
Closed by: ~(r-
Date: ~~ ~ / ~ o / /~
Notes:
Amount Due: Pages for a total of $
Name:
Address:
Agency or firm:_
Telephone #:
Email address:
~~- 10 FAX #: ( ) -
^ check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIP
A ~o ~ ~~~ ION OF RECORD:
~ ~ ~-~~ ~ ~~s -~- a~ ~ `e `,~ ~
~ `I ~ - ~ 4
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