062FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ / ~ /I~
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 ^
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 (Q / ~ / 3
Department Head approval:
(init)
Date Applicant Contacted: / _ /
Date FOIL fulfilled or denied: ~(. / S / ( 3
Closed by: IJ 2 ~
Date: ~ / S /
Notes:
Amount Due: _~ Pages for a total of $ p. ~
Name: /? U - ^ check here if you are
Address: p ~ requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (gqs) Zi? - ~)Z Z FAX #: ( ) -
Email address: ~ ~s ~-
SPECIFIC DESCRIPTION OF RECORD:
~"~~~~1~~w~~z C7 ~t~l utL~~~
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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above