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043FOR 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 ~ / ~ U/ Department Head approval: ~2~ (init) Date Applicant Contacted: ~f / 3~/ l J~ Date FO 'fulfilled o~. enied: ~1 ~__.--- - Closed by: Date Notes: /~~/ l~ `~~ ~/~~/~3 Amount Due: Pages for a total of $ Name: Address: Agency or firm: ~ ~ L-~ ~ ~. ~-'~ a l~' Telephone #: ( ~~ - Oa FAX #: ( ) 3 ~ - Email address: G ~u ~~ ~ ~. ~ cv ~ /COL • ~ o ~-- ^ check here if you are requesting that the records be mailed to this address. lei( SPECIFIC DESCRIPTION ~ RECORD: ~'3~'G~ p0~~~~0~6r~~$~~'4~~ a~aa ,~ ovals DO6 gl~~voo '3 0~~' r~oa ~ ,b©~oo to `~ b0 to /,S (o av® Q ~ o~v 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 C~/' 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