176FOR INTERNAL USE ONLY
Received by: Christine Fulton ~
Jessica Fulton 0
Date Received: 1 " / ,~ / ~ Z
FOIL Ser. #: --~--/~
DEPARTMENT:
ASSESSOR
ACCOUNTING ^ ,
CODE ENFORCEMENT
PLANNING
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES
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:
~~ / -t~5~/^~ 2
`~
(init)
Date Applicant Contacted:
-/._/
Date FOIL fulfilled or denied: / /
Closed by:
Date:
/ /
Notes:
Amount Due: Pages for a total of $
Name: ~T) ~ 1` ~ ~ check here if you aze
Address: ~ 5 requesting that the records
5 be mailed to this address.
Agency or firm:
Telephone #: (~/ ) - FAX #: (~) -~~~'~
Email address: , ~ ~~
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
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton 0
Date Received: (' / .7 / ~?.
FOIL Ser. #:
DEPA T:---_,__
SSESSOR
ACCOUNTING ^ f "
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 ~ / 5` / (2--
Department Head approval: ~ ~~
(init)
Date Applicant Contacted: - / _ /
Date FOIL fulfilled or denied: I 1 / S / ~_
Closed by: N ~ ~
Date: ~/~/~
Notes:
Amount Due: ~ Pages for a total of $ D _ ~b
Name:
Address:
check here if you aze
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (y ) FAX #: (~/-5") -~~~'~~--
Email address: ~ . ((~,(~
DESCRIPTION OF RECORD:
~d"~.. 1 ~ 0 i (~ ~
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 Iisted above
^ I request that the records be faxed to the number listed above