021FOR INTERNAL USE ONLY
Received by: Christine Fulton ^ J
Jessica Fulton
Date Received: a3, / ~ /
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 ^
Name:
Address:
FOR DEPARTMENT USE ONLY
Date Received by Dept _ / _ /
Department Head approval:
(init)
Date Applicant Contacted: off. / ~ /
Date FOIL fulfilled or denied: ~ /~~ /~~
Closed by:
Date: _ ~~/
Notes:
Amount Due: Pages for a total of $
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
f ^ check here if you are
~- requesting that the records
2G~S be mailed to this address.
l iP
Agency or firm:
Telephone #: (FY j )~- a2,~ FAX #: ( ) _
Email address:
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