177FOR INTERNAL USE ONLY
Received by:
Christine Fulton ^
Jessica Fulton ^
Date Received: ~' / ~ / ~ Z
FOIL Ser. #:
DEPARTMENT:
ASSESSOR J'
ACCOUNTING ^ ;
CODE ENFORCEMENT
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: ~ ~G-
(init)
Date Applicant Contacted:
Date FOI~;ffulfilled o enied:
Closed by:
Date:
~'t
Notes: +1~
~/ ? / %~
l( / Sam/ / -?i
/~v/ / rJ
_/ _ /
Amount Due: Pages for a total of $
Name: tl~ ~ ~ ~ ~eck here if you are
Address: ~ ~ requesting that the records
5 ~ be mailed to this address.
Agency or firm:
Telephone #: (y ) - FAX #: (~) -~~~'~
Email address: ~,A ~ ~ ((~,(~
DESCRIPTION OF RECORD:
~ ~.~ 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 listed above
^ I request that the records be faxed to the number listed above