138FOR INTERNAL USE ONLY
Date Received: ~ / ~ /
FOIL Ser. #:
Received by: Christine Fulton `^
Jessica Fulton ~7l
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT ^
PLANNING
.ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER 0
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:
(init)
Date Applicant Contacted: / /
Date FOIL .fulfilled or denied: / /
Closed by:
Date: / /
Notes:
Amount Due: Pages for a total of $
Name: Q/a,/ f~~~/~,S~•/ ^ check here if you aze
Address:, ps,~d2.~~ /~, requesting that the records
-r ~ ~'` i 4 be mailed to this address.
Agency or firm: -~ P.~•-1 d,,i
Telephone #: (g~t~-), ,,~~_~_ Ax #; ( ) _
Email address:
SPECIFIC DESCRIPTION OF RECORD:
~~~ /z ~ti ~ Soh /a~~i ~~ mod'. wQ~~~;rg~s `g/~s
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