016r
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 ^
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 ~i / ~ / /,3
Department Head approval: ~~
(init)
Date Applicant Contacted: 7i / ~ / /,~
Date F L fulfilled denied: Z / ~ / /.j
Closed by: /~-/(~.,
Date: Z / ~0 1 /,3
Notes: ® ~ .,P,!%
Amount Due: Pages for a total of $
Narne:'~S~IQI(J ~D~lCiw- t~Yl 2~ ^ check here if you aze
Address: requesting that the records
~o t,~a It ¢ec~si L' /moo ~ be mailed to this address.
Agency or firm: '
Telephone #: (~{/S-) 23g - 9. 9P ~
Email address: y; s Gib°n~f 00
FAX #: ( ) -
SPECIFIC DESCRIPTION OF RECORD:
r ~ ~D~aQ~i ~~ L~r. ~o.3s~ -p 3 - O ~~?(~-
-7T ~° /
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