023FOR 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 ~ / a ~-~ 3
Department Head approval:
(init)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: ~/ ~.! 1~
Closed by: N 2~~
Date: ~ /a a- / .3
Notes:
Amount Due: _'1 pages for a total of $ ~ . s~
Name: C ~-- ~o ~-G l-f /~ S ~ ~ ^ check here if you are
Address: ~ G ~,~`~ requesting that the records
~ ~ be mailed to this address.
Agency or firm: S ~- o ~--
Telephone #: (~(~) -~~ FAX #: ( ) _
Email address:
SPECIFIC DESCRIPTION OF RECORD
~~~a ~u~~s~~,~~s~a
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