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033FOR INTERNAL USE ONLY Received by: Christine Fulton ^ Jessica Fulton Date Received: ~ / ~/ FOIL Ser. #: r~~ DEPARTMENT: ASSESSOR ^ ACCOUNTING ^ CODE ENFORCEMENT -~ PLANNING ^ ZONING ^ FIRE INSPECTOR ^ HIGHWAY ^ RECEIVER OF TAXES ^ RECREATION ^ SUPERVISOR 0 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 `j / ~/ /~ Department Head approval: ,/~r-- (init) Date Applicant Contacted: rJ / /9 / Date F fulfilled denied: ,.~ / ~ / / ,~ Closed by: G~-J(r Date: ~~ ~/~/~ Notes: ~~'~`~ .~---- Amount Due: Pages for a total of $ Name: ~ ~~.. C,`o~ [; ^ check here if you are Address: I O 2 t,~e sd-o~ /1-y~ A.p~, requesting that the records ~', s j ~"~~~4~ 12524 be mailed to this address. Agency or firm: Telephone #: (gars') 2u 3 - 4zS6 FAX #: ( ) - Email address: `~~v~ ~ /UeJavrz ~~a~~ , r~,•-~ SPECIFIC DESCRIPTION OF RECORD: /~-n Y l'I~c vH; ~-~ i„~ d r k- ~,~~.~ P e.1 7k.2 D~ro4 t~ ~'e _ ~at'.`~i oh S ~4 ~~i.co.+Ts', ~.Qrtc 4 Sods' 3 J .eo~,e~ r-~t © '71 s .~ 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