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055R~G~\~~O 3 ~~N ~ lS~~P~~FOR INTERNAL USE ONLY N 1NG 2o~o~N of PRp.eceived by: Christine Fulton ^, Jessica Fulton ffi Date Received: ,~„ / ~ / FOIL Ser. #: DEPARTMENT: ASSESSOR ACCOUNTING ^ CODE ENFORCEMENT PL NNING ZONING FIRE INS CTOR HIGHWAY ^ RECEIVER OF TAXES ^ RECREATION ^ SUPERVISOR ^ TOWN CLERK WATER/5EWER ^ 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 ~ / / _ Department Head approval: (init) Date Applicant Contacted: ~O/ l~/ ~ Date FOIL fulfilled or denied: ~ / ~~ / l Closed by: Date: ` ~~ ~/~ Notes: ~a s1 l ~ ~ ~~h?~ GC~~.~~~ J -- Amount Due: Pages for a total of $ Name: ~~+~ t~~~~ ^ check here if you are Address: -7~ ' k~~~" ~°~~"~-~_f'' requesting that the records M ~i11n~t (n . JV`T°" c'~`Ct~J be mailed to this address. Agency or firm: ~f~.-Ft~Gs rr Telephone # (973) `I t~- - Email address ^ , f}!0.n , 1~,~. FAX #: (q73 ), ~Ji2 _ 2~/~` SPICCIFTC DESCRIPTION OF RECORD: / - ~St? "~t~~ t Q ltn Gtvlc~ ~' ~IVi(~-ryr1-P.~) ~CcCf'-7~t~i~~iv~ St~f['h Q5 ~~~~t~~ t°tC'a v ~` t C~ ~ "(~i ~ad~.~ otz S~ L^/a- ~... t ~ 2 ~v'i.. i~..,. ~~t -i= ~ ~` ,rl .c arlirl ~.~ ` ? .~ .2. ( y~~„ta~+~ U..t1 J ~1 L:ec~S'~t'~C'J-(f'Lt1 ~s« • wr.~rt ~ ~ [iowxri ~~ xf 2- ((~ G( i' wa ;;Rrr.,~r'"~(Is, FORMAT OF RECORD (if available) ~ ~~ ~ (~ ~~ I request to be notified when I can come to inspect the record(s) d scribed above I request copies of the records described above and agree to pay the cost of such records ' accordance with the fee schedule on the back of this application i~ 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 .~LIG ~~.