195FOR INTERNAL USE ONLY
Received by: Christine Fulton 0 /
Jessica Fulton
Date Received: '~/ ~ / ~-'
~ ,~
FOIL Sera #: C
DEPARTMENT:
~CO~TTING D
CODE ENFORCEMENT C~
PLANNING 0
ZONING C~
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES 0
RECREATION D
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
Name: TASaN a4Ar~ S check here if you are
Address: II 62oq~~A~ , 2f S'r .~oR, requesting that the records
N`l~ ~ IvY I flo 0 4 be mailed to this address.
Agency or firm: a/N'tEG9f- ~G-~n~~'R-LNG- ~ P. C -
Telephone #: (64~b) ~ZZ - oooy FAX #: (2 I Z) ~S - col 8
Email address: ^ P kaS S ®ewz~'ecd - p c . ro n~_ ___.__-- __-_-- __--
~ssc~~ SPECIFIC DESCRIPTION OF RECORD: PIS corm= Z~~- Q~~~x--'R-D, ~L~~-~'~~ ~- o"~'NE/L,
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sc-c~-oN 60~~ twd ~bN~ P~^rc~~1-~ 6~uc.o~, coT3~ya9/,sEarbos~ ~-f~~~n~e~r.
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$~i't~s oN ~ ~ F are -rye Y ~-r.c.. L(.o~-d ? `r~ via ,,~ S ? pt-~rr- ~ r ~ sr~`
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FORMAT OF RECORD (if available)
4. _ I request to be notified when I can come to inspect the record(s) described above
~MI 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
G~ I request that the records be sent via e-mail to the address listed above
0 I request that the records be faxed to the number listed above
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
~r
FOR DEPARTMENT USE ONLY
Date Received by Dept ~~ /~ j
Department Head approval:. .
(init)
Date Applicant Contacted: ~/ ~~ /~~ ~ ~'
Date FOIL fulfilled or denied:
Closed by:
Date:
Notes:
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Amount Due: U~ Pages for a total of $,