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038AP'P,/02/2013/TUE 10:47 AM Conrad Geoscien~e FOR INTERNAL USE ONLY Received by: Christine Fulton 0 Jessica Fulton Date Received: ~ / ~. / FOIL Ser. #: ~~ DEPARTMENT: ASSESSOR ACCO ^ CODE E ORCEMENT ~ ~j~~ ZONING ^ FIRE INSPECTOR .~ HIGHWAY ^ RECENER OF TAXES ^ RECREATION ^ SUPERVISOR ^ TOWN CLERK ^ WATER/SEWER ,~' DOG CONTROL OFFICER ^ TOWN ENGINEER ~ ^ TOWN ATTORNEY 0 FAX No, 845 454 2655 P, 001 2009-10-16 JCM TOWN OF WAPPINGER Application for Public Access to Records FOIL REQUEST aqg-,~7s FOR DEPARTMENT USE ONLY Date Received by Dept ~ /,3 / ~ Department Head approval: ~~. , / ~ ~ J~~, L (init) V~ '/ Date Applicant Contacted: ~ / ~i / / 3 Date FO fulfi or denied: S / Z ~ / /3 Closed by: ~ Date: S~ /27 / /.3 Notes: Amount Due: Pages for a total of $ Name: ~,p(rtCf~tr1 r~ <5.~, Address: (~nr2. C;v~ t GL.n.~r P(acza I'o~ k~~ Si ~ ~JY Z b l Agency or firm: ~V ~ ~ ~ ea" Telephone #: (R~tS) LfS~f - ?,.~~ FAX #: (~'yS) _ Email address: ~Id.roS 2 @ ~~ye~ti~F~'ler. coM 0 check here if you are J requesting that the records be mailed to this address. ~/S~i _ Z 65S SPECIFIC DESCRIPTION OF RECORD: ~l 11 ~JC~. r~~ n~~i~f~ ~ecaraGs ~o r 13 7 a ~o ~J~e ~ lc~cQ.pp; ~~ef-s ~'C~s S~~ L ~l 356gG -b157-0~- 59~168y-yo©D. FORMAT OF RECORD (if available) L~ ~ ~` ,~v~- cr.~e ~ ~ x or 4v~U~i f 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