173FOR INTERNAL USE ONLY
Received by: Christine Fulton ~~
Jessica Fulton ^
Date Received: j J / c.~- / ~
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:
(init)
Date Applicant Contacted: / /
Date FOI~ f'~iilfill or denied: _ / _ /
~.~--~~
Closed by:
Date:
~/ ~/ /3
Notes:
Amount Due: Pages for a total of ~ l°~j~
Name: ~ °`~.
Address: it 1 D
Agency or firm: lr{f~~LL' E'c.~
Telephone #: (~'~ ~' 3 -
Email address:
^ check here if you are
requesting that the records
be mailed to this address.
FAX #: ( ) -
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