028FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR LJ
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING ^
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER 0
DOG CONTROL OFFICE R ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
Name:
Address:
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~_ / ~~ / /3
Department Head approval: _~~
(init)
Date Applicant Contacted: ~ / ~ /
Date F IL fulfilled or enied: ~ /~~ /
Closed by: ~
Date: ~ ~ c3 / ~ /
Notes: ~~ ~ V `~~
Amount Due: Pages for a total of $
^ check here if you are
requesting that the records
be mailed to this address.
Agency or fine: L ~
Telephone #: )_-~~ FAX #: ( ) -
Email address: S~< < v
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 ~ 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