165FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ! ~/ ~ / 1
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 ^
.a
Name:
Address:
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:
(init)
Date Applicant Contacted: ~ //~ / ~ °L
Date FOI fulfille or denied: ~ / ~ / _~.
Closed by: ~~
Date: /(~/~/ ~~-
Notes: ~ ~ o~/ .S~
Amount Due: Pages for a total of $
^ check here if you are
requesting that the records
be mailed to this address.
Agency or firm:~~ ~„ /~ ~~ ~~ ` t~ r~~~ ~ ~
Telephone #: (~Ys~ P9 -~ FAX #: ( ) -
Email address:
SPECIFIC DESCRIPTION OF RECORD:
~~~iQs~ .~ ~S .~ m A,t- ~~i Zft ~ Z
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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above