009 (2)-
FOR 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 0
RECREATION ^
SUPERVISOR ^
TOWN CLERK
DJATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER ^
TOWN ATTORNEY ^
2009-10-16 JCM
--TOWN QF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / J~ / / ~ 3
Department.Head approval: ~_
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: / ~ / ~ ~
Closed by:
Date: ~/ I /~~
Notes:
Amount Due~~ Pages for a total of
Name:
Address:
Agency or firm:_
Telephone #:
Email .address:
^ check here if you are
requesting that the records
be mailed to this address.
_s21~-'~ T
SPEC~IC~D>~ RIP~~~OF RECORD:
FORMAT OF RECORD {if available)
0 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
0 I request that the records be faxed to the number listed above
~?,l -~ci~ FAX #: