196FOR INTERNAL USE ONLY
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Received by: Christine Fulton ^ /
Jessica Fulton
Date Received: ~/ ~ /
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FOIL Ser. #:
DEPARTMENT:
ASSESSOR Gds
ACCOUNTING ^
CODE ENFORCEMENT
PL '
ZONING Q~
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 / Z //~ / / a
Department Head approval: ~(--
(init)
Date Applicant Contacted: / Z / /,~ / / Z
Date FO fulfilled r denied: / 02 // ~ / % ~
Closed by: /~~ ~,t- /~ ~
Date: 1~f0/ / ~ / / 9 / / ~-
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Notes: y'~~"'"
Amount Due: Pages for a-total of $
Agency or firm:. Er.+TECI~{- ~rFt~,~~R,~vG- ~ P, C _
Telephone #: (64b) ~ZZ - oopp FAX #: (2 ~ Z,) ~- Sc~~ g
Email address: P kas s ® ew~'ecli -p ~ . ro n
Name: TASc7N ~q-SS C~Ycheck here if you are
Address: I~ ~(2~q~c~Jq~ , '2.( sir ,~o~ requesting that the records
N`-~ ~ fu`r' loo 0 4 be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: PIS co~irn-: z+2 ,2+v~x-~-D, B~°uL~-tor ~- oWN~i2,
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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
~I 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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above