198FOR INTERNAL USE ONLY
Received by: Christine Fulton ~
Jessica Fulton ^
Date Received: /~ /cal /
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: / /
Date FOIL fulfilled or denied: ~ / a ~ /I a-
Closed by: ~{~,,~
Date: L / a ~ / 1~
Notes:
Amount Due: ~ Pages for a total of $ 1.7 S
Name: ~ ~l u`Et,6 EAU, ~ 5 C'o Q~ y tig~Cl. 4 ~' ~ ^ check here if you are
Address: ~ S 1 requesting that the records
Po UG'111~CG~°~)~ be mailed to this address.
Agency or firm: ~ r" i~ rn~a3 G"~C.
Telephone #: (~ys) ~f5 - ~aS FAX #: ( ) -
Email address:
SPECIFIC DESCRIPTION OF RECORD:
l ~~ ~ ~U~T~ C1 ~E C Cx~D ~.~2 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