181FOR 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 ^
VdATER/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:
(init
Date Applicant Contacted: ~ / ~ / L~
Date FO filled denied: ~ / ~/ ~
Closed by:
~-l~
Date: ~~ ~ ~ / ~/
0/V~/ /
Notes: o N ~i~ ~
Amount Due: Pages for a total of $
Name: ~ N_ J , hl ~ " --1 ~ i ~ :~ :'Y. ^ check here if you are
Address: ~ ~ ~ ,~,: , ~ , 4s, r-~ ;~ ~~ .~ requesting that the records
a ~ ~ "' "'^ ~ ~ ~ ~ ~ ~ be mailed to this address.
Agency or firm: x , ~
Telephone #: (~ ~.j r) ~r z~ - u ~, '3 FAX #: ( ) _
Email address: _ ih--;,, ~ ••, s t{ ~ s ,, ~.~F~ •n ~..
SPECIFIC DESCRIPTION OF RECORD: ~
ti ~ L ~ 1- v ~ ~.~1 i~.~ ~- ~ `~ ' ~~ l~ 1 1-l. V"~
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