02FOR INTERNAL USE ONLY
Received by: Christine Fulton '~
Jessica Fulton ^
Date Received: ~ / ~ /
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 ^
Name:
Address:
Agency or firm: _
Telephone #:
Email address:
SPECIFIC DESCRIPTION OF RECORD: (~ p ~
~ t.~F,: ! .~~~~'1'e t.. e. ~ ~ p~ ~, Irk ~ 5 ,~~ ,..
~,.
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 e-mail to the address listed above
^ 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
FOR DEPARTMENT USE ONLY
Date Received by Dept _ /~
Department Head approval:
(mrt)
Date Applicant Contacted: / /
Date FOI fulfille or denied: ~ / ~ / / -~
'~
Closed by:
Date: ~ / L~ / /~
Notes:
Amount Due: ~ Pages for a total of $
i~- ^ check here if you are
~' requesting that the records
be mailed to this address.
- r,~1 ~:.., FAX #: ( ) -