160FOR INTERNAL USE ONLY
Received by: Christine Fulton ~
Jessica Fulton ^
Date Received: % ~ / ~ / ~ a" "
FOIL Ser. #: ~~
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING ^
ZONING
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK Q~
WATER/SEWER 0
DOG CONTROL OFFICER 0
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:
Date Applicant Contacted:
~~ / ~ /~~'
(
Date FOI fill d or denied: ~ ~ / L/ I /~"
Closed by:
Date:
/U/ ~ //~"
Notes: ~(~1 (,~~~'
Amount Due: Pages for a total of $
Name: UL~ t ~I-,t~y~ ~ ~} 1-~~n,,..t
Address: lg ~~Ic
Agency or firm:
Telephone #: (~~ - S/03 FAX #: ( )
Email address: 2~a~~4..~,g~~ . Cow
SPECIFIC DESCRIPTION OF RECORD:
^ check here if you aze
requesting that the records
/~S'~be mailed to this address.
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