003FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton ^
Date Received: ~ / ~/c~-yl ~~
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: 1 / ~ ~ ~ l
Date FOIL fulfilled or denied: _ / - /
Closed by: N 2 ~-
Date: ~ / ~ / 1 ~-
Notes:
Amount Due: ~ Pages for a total of $ _ o 0
Name: ~~ c,~.. ~~ ^ check here if you are
Address: LI U L..G. ~` v ~`,c~ s Sc~; ~ / 2 ~ requesting that the records
~a.~o N Y ~f-12O2 be mailed to this address.
Agency or firm: Lc~ec ~6h 5w1-1~; ~5 S~~«eS
Telephone #: (~~~) 66~ - 4`rZ FAX #: ( ) -
Email address: rhJacr~ (~ t ev~dQ,~I- CatnS~n~~; ~~ •c.G w.
SPECIFIC DESCRIPTION OF RECORD:
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