027FOR INTERNAL USE ONLY
Received by: Christine Fulton ^ ,
Jessica Fulton
//~
Date Received: ~/J /
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: ~ / ~ / !3
Closed by: ~ P,A-
Date: _/_/
Notes:
Amount Due: ~ Pages for a total of $ ~ • `]
Name: 19~~~~ l_,~-LI ~ ^ check here if you are
Address: - w~E ~,~ 5~ requesting that the records
U k ,, ~ ~l ~ be mailed to this address.
Agency or firm: EZ L
Telephone #: ( ) - ~~a 5 FAX #: ( ) -
Email address:
SPECIFIC DESCRIPTION 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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above