061FOR 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 ^
DOG CONTROL OFFICER ^
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 ~ / ~ / ~_
Department Head approval:
(init)
Date Applicant Contacted: _ / - /
Date FOIL fulfilled or denied: (~ / ~ / ~3
Closed by: ~.f (Z,f~-
Date: ~./~/L~
Notes:
Amount Due: Pages for a total of $ ~®
Name: !L 22 ~ ~ • ~ Gt U i d S 0 ~ ^ check here if you are
Address: _C ~ I'Y1 ~ n~ Cl. O!L i ~ 2. requesting that the records
~.1a i nnp~~ll~ N y ~~gQ be mailed to this address.
Agency or firm:
Telephone #: ($~(S7 757 -2.99 FAX #: ( ) -
Email address: Q ~J~S+ (~+'l l~, ~L. ~ C D (Y1
SPECIFIC DESCRIPTION OF RECORD:
i~ ~ ~'7 - nom. -- 9's"s 8` 1 O
d -F' G7 e
FORMAT OF RECORD (if available)
C~~ I request to be notified when I can come to inspect the record(s) described above
L ~ 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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above