006FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton ^
Date Received: ~ ldal~
FOIL Ser. #: (Jl
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: ~ / ~ / ~_
Closed by: ~ J~
Date: ~ / ~/
Notes:
Amount Due: ~ Pages for a total of $~_
Name: 'T~~^ o,ne_ ~r tf Olnrx~L~ ^ check here if you aze
Address: requesting that the records
~ ~)c~~f~ 1-~lc~n~ Fd ~ ~ S y 1 ~5~ U be mailed to this address.
Agency or firm:
Telephone #: (gy ~) ~1 $ -~ & ~ ~] FAX #: ( ) -
Email address: _~rn Y~2 _,.~ ~ ~ ~1 ~~r~ 6 ~.+ (,,p /~/\
SPECIFIC DESCRIPTION OF RECORD:
C~ Au a F ~-e ~e rJ
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