185FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton ~j
Date Received: l c~ l ~ l ~a`
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 ~ ~/ ~ / / ~
Department Head approval:
(init)
Date Applicant Contacted: /02/ (r / /a
Date FOIL fulfilled or denied: /a / Z /
Closed by: /~/~~
Date: ~/~~ /
Notes:
l~l.Q
Amount Due: Pages for a total of $ 1
Name: ^ check here if you are
Address: b S z' requesting that the records
/L be mailed to this address.
Agency or fum: ~ ~ rao r ,~
Telephone #: ( ~') - G~ ~ FAX #• ) -
Email address: I ~ ~ - ,~+-~v . Gv~
OF RECORD:
I _ ~/ ~^ ,
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
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