178FOR INTERNAL USE ONLY
Received by: Christine Fulton ^ ,
Jessica Fulton ~'
Date Received: ~ / ~ /
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:
(irut)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: / /
Closed by:
Date:
Notes:
/ /
Amount Due: Pages for a total of $
Name:
Address:
^ check here if you aze
requesting that the records
be mailed to this address.
Agency or firm: ve' ~
Telephone #: (8yf) Wl~y -OV~~.,, FAX #: ( ) _
Email address:
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