179FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton ^
Date Received: ~ / ~ /
. ~ C,
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 1~ / 1S / 12-
Department Head approval: ~~
(init)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: / /
Closed by: ~~
Date:
Notes:
\~/~/~Z/
Amount Due: Pages for a total of $
Name: ~~~ ~G% ~ ~.Sa .~~ ^ check here if you are
Address: /s~ tiI,~o//e%~, ,~ ~2 requesting that the records
~r/a~~T ~g/~s ,; ~ L be mailed to this address.
Agency or firm: ~1( ~
Telephone #: ~~J` -. -=-_~._ FAX #: ( ) -
Email address: .S',~.9.7 E' . 7 i1~ ~ a~ %G n /;':, ~ : ~z T ~ Lf.~~ y~'~ ~~ .~ 7(0
SPECIFIC DESCRIPTION OF RECORD:
~;s'i tsF P(cy~.~~v ~Rx~ ~ o,.~E+~ ~ ,. \r.,r.,fl,~ ~A1~S
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