011 (2)~'
~;,~
,1
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton ~
Date Received: ~ /~ /
FOIL Ser. #:
DEPARTMENT:
~
ASSESSOR ^
~'O,~
ACCOUNTING ^ ~°
CODE ENFORCEMENT ^
PLANNING ^
ZONING
FIRE INSPECTOR ^
HIGHWAY ^
RECENER 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 1 / 3 ~ / ~u~ 3
Department Head approval: '
(init)
Date Applicant Contacted: _ / _ /
Date FOIL fulfilled or denied: ~ / i / 20 i-5
Closed by: ~ (Zab~.~1S
Date: ~ / 1 / ?oi 3
Notes: ('~=1~~~. 1 -b~e_ L ; " ~~p ~1~~.~~
- -~
Amount Due: / Pages for a total of $ ~
Name:
Address:
Agency or firm: '
Telephone #: (g~ -- FAX #:
Email address:
^ check here if you are
requesting that the records
be mailed to this address.
_ r~~
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 a-mail to the address listed above
^ I request that the records be faxed to the number listed above