175FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ / .~ /
~~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR C~
A COUNTING ^
CODE ENFORCEMENT
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY 0
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 F fill or denied: !(/ S % / L
Closed by:
Date: ~ Q . ~ / ~/~ ~
ao
Notes: ~~
Amount Due: Pages for a total of $_
Name: % ~C/ f'I /'~ ! }--~ ^ check here if you aze
Address: requesting that the records
L° P be mailed to this address.
Agency or firm: ~ ~' '
Telephone #: ( ,~") as 7 - FAX #: ~~ _~~ 17/ ~
Email address; ~ D v/ Gr.~~/ fP~2 .COQ-~
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