056FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ /~.J/~
FOIL, Ser. #: ~(0
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT '~~
PLANNING
ZONING
IRE INSPECTOR
HI AY ~
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 5 / ~ /
Department Head approval: ,~1~
(init)
Date Applicant Contacted: J I ~ ` /
Date FO lfilled or Hied: Y~ / ~/
Closed by: `~
Date: ~^ ~ ~ - ~/ Z ` / C/~
Notes: ' " °~- ~~`-e
Amount Due: Pages for a total of ~
Name:
Address:
Agency or firm: ~.#~~ l ~" ~~n~: r~
Telephone #: (973) `~- ~.~~ FAX #: (q73 )
Email address .. ~Y0.~ ~~tn.~+.t~~!;~?:+rrlc'~. C'~"'l _~ ..............
^ check here if you are
requesting that the records
be mailed to this address.
_ 2~/~'
SP~CIFIC DESCRIPTION OF RECORD: /
a ~.a5~ 1~~~, /~ 2 Vin; ~~ ~( ~IVi(~r1~~2di G~OCtln7~l~,~fc~~ S~.h c~5 ~~~'r~~`~
~~ls"a "v• s` i ~.~" ~ ^(;~ ~d~t'` c~u .S' att. ~ 1~ ~:. ~i• ~ ~~... pct -t~
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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~ I request that the records be sent via a-mail to the address listed above
1 request that the records be faxed to the number listed above
~~.