161FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton ^
Date Received: ~ ~ / ~ /
FOIL Ser. #: ~~
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 `~ / ~ / ~
Department Head approval:
(mit)
Date Applicant Contacted: ) ~ / ~ /
Date FOIL lle or denied: ~ U ~ /
Closed by:
Date:
Notes:
~/ ~ /~~' ,
Amount Due: Pages for a total of $,
Name: ~ 0 5 h e A s ti ^ check here if you aze
Address: O `130, ~°~'~ 7 requesting that the records
Wc~ p ~r n Ge ~r s ~~ (1 S ,~.~ ~ ~ 2 s Y ~ be mailed to this address.
Agency or firm:
Telephone #: (?~45) Z r - ~ / FAX #: ( ) -
Email address: J PJ~ C~ r ~ (c'r ~ ~ ~ c~ o I • c o r1
SPECIFIC DESCRIPTION OF RECORD:
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