184FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton ^
Date Received: ~~.~/ ~t
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 ~, / ~/~ a
Department Head approval:
(init)
Date Applicant Contacted: ~/ ~ /~'~
Date FOIL fulfilled or denied: / /
Closed by:
Date:
/ /
Notes:
Amount Due:
for a total of $
Name: ~ 1lC.vv~. ~`.~ ^ check here if you are
Address: E, requesting that the records
- be mailed to this address.
Agency or firm: ~.:
Telephone #: (s~s~- -_~~c~~-F'AX #: ('~~,,! Sj S"%~-~S~S~~
Email address:
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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above