012(~os'7- oY-R~'o~ l a
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ l ~ l ~ J
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 0
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
RECEIVED
BUILDING DEPARTMENT
TOWN OF WAPPINGER
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
~~
Date Applicant Contacted:
/ !~l / ~~
Date FOI fulfille z denied: ~ / ~ /
Closed by: ~- ~ ~ ~~"'
Date: ~ ~ 1
~/
Notes: ~ ~1i~~5 ~if~~l ~
Amount Due: Pages for a total of $,
Name: L ~~i4-~/~ vZ~E~ check here if you aze
Address: /S 1'h I SK L~9-Ne requesting that the records
Gv~l'1°I°iN6e~ F~wS N~ /~-sYt~ be mailed to this address.
Agency or firm: C_~2 C
Telephone #: (~s ~e5' ) a~8 - 0 3 ~- FAX #: ( ) -
Email address: ~~ ~16 ~~
SPECIFIC DESCRIPTION OF RECORD:
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~o ~~. 7'~x M A-P r-,o~tCL~k Tvw~Ho~S~ f}-c- ~n,P DL~ve
FORMAT OF RECORD (if available) ~ (1, t`~~~d- d~ ~ -" -~
^ 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
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