187FOR INTERNAL USE ONLY
Received by: Christine Fulton "~l
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 ~ a ~Q l l'a
Department Head approval:
(init)
Date Applicant Contacted: _ / _ /
Date FOI lfille or denied:l~/ ~ / ! ~-
Closed by:
Date: ~~/~/ (~-~
Notes:
Amount Due: Pages for a total of $
Name:
Address:
Agency or firm: ~
Telephone #: (~~t,~"")
Email address:
^ check here if you are
requesting that the records
be mailed to this address.
FAX #: ( ) -
SPECIFIC DESCRIPTION OF REC RD:
DhN D
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