066FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~D/,~ / ~~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR L~
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:
(init)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: (p / jn / ( 3
Closed by: ~ ,2~-
Date: (o / l v / i 3
Notes:
Amount Due: Pages for a total of $ 1 !Q::So'
Name: ~d~ Cc~k~Y ^ check here if you are
Address:. ~S- ~c~Ch~~~f1[~ ,/~Jc~r requesting that the records
` be mailed to this address.
Agency or firm: c ~ i .. • ~.
Telephone #: (~~l,~-) -~~ FAX #: ( ) -
Email address: ~~5~ / y L. ~/, c~
SPECIFIC DESCRIPTION OF RECORD:
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