156FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: L / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR 0
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / a. / 12-
Department Head approval: ~~
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: ~ / a- / ~ ~-
Closed by: N 2,~
Date: _[o / ~ /
Notes:
Amount Due: ~ Pages for a total of $ ~`
Name: ~r~~~-i!~ ~ lz,F~r./ ^ check here if you are
Address: _~~~,y~y~¢ la /0~9 ~/,~>,~~T- requesting that the records
LZ~ y i~~ 1~ be mailed to this address.
Agency or firm: t ~~
Telephone #: (F¢~) - ~3 33 FAX #: ( ) -
Email address: ~ f~~ D ~Y.~R~ ~ ~o , Co.~
SPECIFIC DESCRIPTION OF RECORD:
~G-~G Q~C/~~~Tl6.c~ Df /~ s% N/C~al~~
~ /06,0 iQouT~ 37~
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