020FOR INTERNAL USE ONLY
Received by: Christine Fulton ^ ,
Jessica Fulton L(
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 _ / / _
Department Head approval:
(init)
Date Applicant Contacted:
Date FOIL fulfilled or denied
Closed by:
Date:
Notes:
Amount Due:
/ /
/ /
~/~ 2 /~
Name: I`~~ u~~ Y ^ check here if you are
Address: M t LL. v "' requesting that the records
a ` , . ~( (vim J, ~ I be mailed to this address.
Agency or firm: 1 0 ~.! ~`~
Telephone #: (8'~~'~ `f - S7o s FAX #: ($tiFj) ~S'~- S~ l u
Email address:
SPECIFIC DESCRIPTION OF RECORD• _
W ~ J ~-`-S N -`
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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