041FOR INTERNAL USE ONLY
Received by: Christine Fulton `~
Jessica Fulton ^
Date Received: ~ / ~ / / 3
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 ~ l l S/c.3~) f~
Department Head approval:
/ (init)
Date Applicant Contacted: L (/ l ~~ f
Date FOIL fulfilled or denied: ~/ ~~/ ~.~--~ 1,3
Closed by:
Date: ~/ ~ ~ ~
Notes:
Amount Due: Pages for a total of $
Name: ~ C~.P4 / 0~2 /' ~ ~~ ^ check here if you are
Address: requesting that the records
`~-v u- ~ ~ 2 be mailed to this address.
Agency or firm: ,1 !~f b ~ a~
Telephone #: ~~{,~) ~ 2 ~~ FAX #: ( ) -
Email address: t,J ~ G ~ Gk~ ~ (.c G'v~+
SPECIF`I~ 3 ~~ C ~ T ON F RECORI?•
~ ~ _ 7 0 C~ ~
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