1362009-10-16 JCM
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FOR INTERNAL USE ONLY
Received by: Christine Fulton ^ ,
Jessica Fulton yl~/
Date Received: ~ / ~ /
FOIL Ser. #: '~
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT 8/
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / ,~/ /o~
Department Head approval: ~- s'/y
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Date Applicant Contacted: / / ~/ ~ Z-
Date FOI it or denied: ~ / ~ / / ~.
Closed by: ~~ S
Date: ~ / 5~/ / Z
Notes:
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Amount Due: Pages for a total of $ .
Name: ~c~w•-. ~„~~.; ~~-+~,~•..~ ^ check here if you are
Address: ?v ~1,~..c.., ~ m,~ pct . requesting that the records
be mailed to this address.
Agency or firm: W l-; ~-~- ~~~ t~•Ka F •" ~ °`- j ^ C,
Telephone #: (~+3 ) ~~~ - `i-1 1 FAX #: ( ) -
Email address:
SPECIFIC DESCRIPTION OF RECORD:
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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