No preview available
059FOR 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 0 TOWN CLERK ^ WATER/SEWER ^ DOG CONTROL OFFICE R ^ TOWN ENGINEER 0 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 ",~ / o~ l ~ 3 Department Head approval: (init) Date Applicant Contacted: / / Date FOIL fulfilled or denied: ~'/ ~ / 13 Closed by: ~,2,~- Date: ~/~/~ Notes: Amount Due: ,~ Pages for a total of $ D. 7 Name: ~.LIG ~~er h -e ov1 b~hc~ ^ check here if you aze Address: Z Sca 3' ~~~te.~, requesting that the records at,~ ~ u - Z T~ c , be mailed to this address. Agency or firm:~17J ~~'one,,r}~,QS cwrLes i mnt~, r ~rv,~'~5arna~Tarnp)c~r~~ Telephone #: (~`ts )~23 - ~?c~ FAX #: (~4s )~.z3 - 9?coo Email address: 1 iris ~t-~~ 'rl~d.o~e® ~, ,cam SPECIFIC DESCRIPTION OF RECORD: l7 eecl~~- 1 C~ MGM' l~-e~- 5~ r~ e~- t~-t~r~- n Qe 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 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