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058FUR 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 DOS CONTROL OFFICER 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: r„ / ,_,,,,- / Date FOIL fulfilled or denied: i / _ / Closed by: Date: ~ / ~~r / Notes: e ~5 Ca GZt ! ~( ! "- W © ~P~ jE'~ Amount Due: Pages for a total of $ Name: ~+~ ~~ ^ check here if you are Address: :~-7 ~ ~n f: ~'~t"-~:~_ requesting that the records ~tl~ "' ~?~ be mailed to this address. Agency or firm: ~:.~-~l, ~~ ~~ ~~~ Telephone #: (~j 73) `[ t ~- - 7..~~~ FAX #: (`~ 73) ~ ~~- - Zy~' Email address ...~Yan Ic+.~.~.~,:.~C:~+rr~,c1~}". C~?+".1 ........_ ......... SP ~CIFIC DESCRIPTION OF RECORD: ~~~~ltSt? %ife'~l2 ~~ and ~1 ~Iv;(~~?~~I ~cum~r~~~~~r, Soh ~s ~"~~'~{~' i'1!a ny ~ t` i Cyr "(,~t ' ~ad~( r~u .~' ~/~- t~ t k' ~. vrti• ~ i~ ~~. t ' ~ ,C Cr1tC~ ~. ` M4 ( ~ ^~. ~ ~'~"t~ ~f # ~I ~Cc~S~t,S~."~1~4t~ r- r/ i V~GV! "C? ~ ~ I ~~ W tri ~i. c f~ ~. '" r tF' ~ 1 ` ~ iFt~ t'.,~ t`r E+5, FORMAT OF RECORD (if available) ,!~ I request to be notified when I can come to inspect the record(s) described above I request topics 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 _ I request that the records be faxed to the number listed above / V ~.