189
FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton ^
Date Received: ~a /~ -] / / ~"
FOIL Ser. #: 1
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ~1
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 / off- /V ~7 / / ~
Department Head approval: ~_
(init)
Date Applicant Contacted: 1 ~ /C~~ / ( a
Date FOIL filled r denied: ~ ~ /v`7 / ~ 3
Closed by:
Date:
/ /
Notes:
Amount Due: S~ Pages for a total of $
Name: YYl + ChGc.~.. l ~`.~~ n
Address:
Agency or firm:
Telephone #: (~~S) („~F-1-~JO FAX #: ( ) -
Email address:
DESCRIPTION OF RECORD:
^ check here if you aze
requesting that the records
be mailed to this address.
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