154FOR INTERNAL USE ONLY
Received by:
Christine Fulton ^
Jessica Fulton
Date Received:
FOIL Ser. #:
/ oho / !~.
i~L
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ~
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ~
TOWN CLERK ~
WATER/5EWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQI~EST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / ~' b / ~ ~
Department Head approval:
(init)
Date Applicant Contacted: `% / a~ / ~ ~
Date FOIL lfilled r denied: ~ /a ~ / 1 ~-
Closed by:
Date:
lo~ila-~
Notes: ~ ~ ~-~ ~ l ~'/y1n ~ ~ D
Amount Due: ages for a total of $~=
Name: C ~l QQ L~,,S DA 1/~ ~1 P o 2 i ^ check here if you are
Address: 3 5 N f~ c. PI N~ ,~2~1 / r requesting that the records
W R (' P /~U d-~~s ~p-~.~ N Y be mailed to this address.
Agency or firm: ~ C ~. F
Telephone #: (~~{,~) ]~D - ~ o FAX #: ( ) -
Email address: S A L~ Y /f Atil M ~~AO ' G on.c
SPECIFIC DESCRIPTION OF RECORD:
~~ o s its O } % p W ti i= v N Ds !t~ ~ 8~4N~CS ? Ef ~~- ~1RL D ~Pt3t~T ~ iitl
14~~ ,~j~NG ~~L- /NS7~Uat~V7s /A3 wlt~ct-r
TDUJp lGy Q.'-ns ~4,~~ i N cl~S7.=
lt> l LL /~{ /~ C CaPI cS D F G~i ri~N d i~ 7~C DD ~~- L~ 1=-~T S
FORMAT OF RECORD (if available)
f~ 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
~~~t-Z7~-l~Z