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174.~ FOR INTERNAL USE ONLY Received by: Date Received: FOIL Ser. #: Christine Fulton ^ Jessica Fulton ~/~ / ~~y ASSESSOR Q' ACC CODE ENFORCEMENT ~~ PLANNING ^ ZONING ^ FIRE INSPECTOR ^ HIGHWAY ^ RECEIVER OF TAXES ^ RECREATION 0 SUPERVISOR ^ TOWN CLERK ^ WATER/SEWER ^ DOG CONTROL OFFICER 0 TOWN ENGINEER ^ TOWN ATTORNEY ^ 2009-10-16 JCM TOWN OF WAPPINGER Application for Public Access to Records FOIL REQUEST FOR DEPARTME11~bTt~}~i~d~isY Date Received by Dept ~.1L ~~~~~_ Department Head approval: TOWN ®~ V'JA9k~GER ASSESJC)R'S ©Fr=YLE Date Applicant Contacted: _ / _ / Date FOIL fulfilled or denied: ~ / ' ~ v~ Closed by: Date: / / Notes: Amount Due: Pages for a total of $ Name: % ~C/ `7l') / ~--~ ^ check here if you are Address: requesting that the records L° ~ be mailed to this address. Agency or firm: ~ (' ''` Telephone #: ( ,~) as 7 - FAX #: (~~ _.~%Z~`-LL Email address: ~ p ~// ,rp~,e 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