157FOR INTERNAL USE ONLY
Received by: Christine Fulton ~]
Jessica Fulton ^
Date Received: /~ l 3 / ~ a
FOIL Ser. #: 15 ~"
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
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 r"~ / ;~ /) ~
Department Head approval: ,i,J ~,~-
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: / /
Closed by: ~' ,e;~
Date: / /
Notes: ~ l a ~;~,,, ~~~
Amount Due: Pages for a total of $ -
Name: ~'~~~~~ ~ ~ i ~ y y~ L c ieck here if you are
Address: ~ R ~,,; ~ ~-~ ,q-,~.~ ; ~t ~ requesting that the records
be mailed to this address.
Agency or firm: E y ~- N ~ ~ ~ ~ l~ ~ ~'s~: ~~, ~'tr
Telephone #: (~~'~(5) a a Z- ~ 3 5 ~ FAX #: ) -
Email address: 2v~,~y~ ~ i xo -~ (~~ ~~ ~. C v ~
SPECIFIC ESCRIPTION OF RECORD:
~ I... ~. 'Lid G~ ~~ Yr~ Dti ~~' 3 Gt~ ~iC-t~.- ( V
FORMAT OF RECORD (if available)
lP' I request to be notified when I can come to inspect the record(s) described above
C~ 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
C~ 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