065FOR INTERNAL USE ONLY
Received by: Christine Fulton ~J
Jessica Fulton ^
Date Received: (J1 /l ~ / ~ ~
FOIL Ser. #: ' J
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
Department Head approval:
(~~0~ ~ (~ -~~-~3
Date Applicant Contacted:
:_.-,
Date F fulfilled r denied:
Closed by:
/~~ /~ 3
~~
(init)
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wl/l l/3
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Date: ~ / /~ /
Notes:
Amount Due: Pages for a total of $
Name: /~C G ~ ~ o .J ~ ^ check here if you are
Address: ~.,s,~ ~ R~ ~~- requesting that the records
~~- `~-n~L ~- ~c.~ N`i ~ ~ 3 ~ be mailed to this address.
Agency or firm: ~Q ...~ a ,,, -r- , ,,, ~ s` r~,,r~ L f
Telephone #: (9~ ~) ~ ~ -~7 FAX #: ( ) -
Email address: ~/ nti c G-c~ v q I~~ ~•• o ~ . C a .~..
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SPECIFIC DESCRIPTION OF RECORD:
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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 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
...