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141FOR INTERNAL USE ONLY Received by: Christine Fulton ^ Jessica Fulton Date Received: q / ~/ FOIL Ser. #: DEPARTMENT: ASSESSOR ^ ACCOUNTING ^ CODE ENFORCEMENT PLANNING ^ ZONING ^ FIRE INSPECTOR ^ HIGHWAY ^ RECEIVER OF TAXES ^ RECREATION ^ SUPERVISOR ^ TOWN CLERK ^ WATER/SEWER p DOG CONTROL OFFICER ^ TOWN ENGINEER TOWN ATTORNEY ^ Name: Address: V 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: ages for a total of $ ~, ~ s ~5~ u Agency or firm: Telephone #; (~S) ~ _ ~O(o2 FAX #: ( ) _ Email address: I~~'P,v-~ '!~ @ Ya.(~aio .rmw~ ^ check here if you are requesting that the records be mailed to this address. SPECIFIC DESCRIPTION OF RECORD: ~ W eMLd `~i K-e.. C C . o ~ ~~ ~~e~eoR ©.~ -~(n.~ ~•,~t ~, s g. ~ YeSlra u~t ~ ~ d J) ..rf a /~ V 1 n ~. S l~ b 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