019FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton ^
Date Received: ~ / ~ / /,~
FOIL Ser. #: q
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT `~
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES 0
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER 0
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 ,Z / ~ /
Department Head approval: ~.{(~-
(init)
Date Applicant Contacted: ~ / / ~ /
Date FOI fulfilled r denied: Z/ ~~ / /.3
Closed by:
l~~
Date: ~ / j~ / ~ 3
Notes: ~D ~'°0 ~a
Amount Due: Pages for a total of $
Name: __ /~,A.ZtC.
Address: 22-~E t
Agency or firm:
Telephone #; (3'q?) ~2~- iU
Email address: val ~ ~r_ ~.., ,. ~/.
~"~ ~ ° N ^ check here if you are
~ r ~ ~` requesting that the records
~4-N~~ /f'~ (0 3 l v be mailed to this address.
FAX #: ( ) _
ov ~ Q.~! ~
SPECIFIC
- ~--
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