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137
FOR INTERNAL USE ONLY
Received by: Christine Fulton 0
Jessica Fulton
Date Received: ~ / ~/
FOII, Ser. #: ~~
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING
ZONING 0
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION 0
SUPERVISOR 0
TOWN CI;ERK ^
WATER/SEWER ^
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FDIL 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:
Name: ^ check here if you are
Address: ~ requesting that the records
be mailed to this address.
Agency or firm: j
Telephone #: (~j ) ~-, FAX (~5) ~~
Email address:
FORMAT OF RECORD (if available)
I request to be notified when I can come to inspect the record(s) described above
Irequest copies of the records described above and agree toffy the eost_of such records in
accordance with the fee schedule on fhe back of this application
0 I request that the records be sent via a-mail to the address listed above
0 I request that the records be faxed to the number listed above
