182FOR INTERNAL USE ONLY
Received by: Christine Fulton ~I
Jessica Fulton ^
Date Received: ~ / ~ / % ~
FOIL Ser. #: / ~Z
DEPARTMENT:
ASSESSOR ~,
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR 0
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept /Z / o~ / /~?
Department Head approval: `c ~.
(init)
Date Applicant Contacted: /a / d,~ / / z
Date FOI fulfilled denied: ~ Z/ O 3/ / Z
Closed by:
Date:
~~
Notes:
~~
/Z/ 03/ /Z
oi/ ~Lc
Amount Due: Pages for a total of $
Name: ~ ry ~ ~ ~ Q:, ~ ; ^ check here if you are
Address: _ ~'7(0 ~3 - ~ ~ 1 l tut -c ~ ~ ~ requesting that the records
~~ ~ w~ ~- V ~ ~ ~' _~ be mailed to this address.
Agency or firm: , lU
Telephone #: (C,31) G ZS. - 4 SL'3 FAX #: ( ) -
Email address: 1E,~;,;u,~.S 1.~2?v~Yc P u~
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