194 (2)FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~o~/ ~ / ~_
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER 0
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 ~. l 1 t l I ~-
Department Head approval:
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: r ~/ 1 I / !~-
Closed by: _ ~ 2,A
Date: ~ / I 1 / ~
Notes:
Amount Due: ~ Pages for a total of $ l . a S
Name: ~ ~ t'~ n- ~ y ^ check here if you are
Address: ~'~ '~ ~ ~ ~ v~ ~~ ~ requesting that the records
C ~ ~ S ~ ~- ~ ~ a S~ ~ ~ be mailed to this address.
Agency or firm: ~ ~~sa-• ~ ('~ ~ Y yi. ~ ~ .e w ! h ~ ~--
Telephone #: (~/ s~ ~ G s - u ! t FAX (~cJ.1~ 2 C~ ~ ~- ~.! 3'
Email address: fir. ~ c-Q. ~ ~ ~, ~~ L~ r 2 e i~ e ~ 1 ~ . ~.~d-~
SPE ~ I~ DES~RII'TIO~CO~tD:~ 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