071a
P~:~o~2~-t,.i ~~S ~icaa
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
A OUNTING ^
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 RE(~, UEST
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
Date Applicant tacted:
Date F fulfill or denied:
/ /~~/~,~
(init)
/~/ ~~
/~/ /3
Closed by:
Date:
Notes:
~w
~/ 7 /
Amount Due: Pages for a total of $
Name: ~" T'
Address: 2S ~lw~ i
^ check here if you are
requesting that the records
be mailed to this address.
Agency or firm: ~'I (y k~.~wt~ t-i X421 ~-1- T~.~lt ~a.~. 'P ~1C_
Telephone #: (t3~i 5'~ y l''~ - 0 FAX #: ($ ~{ ~ y 7 ~ -
Email address:. rZTD~rler~,_ i nic-o~,rci~l ~~__
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SPECIFIC DESCRIPTION OF RECORD: - ~,~ ~ g ~"
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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 a-mail to the address listed above
^ I request that the records be faxed to the number listed above