054FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton ~,
Date Received: ~„ /~/
FOIL, Ser. #: ~~~
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
('nnF. F.NFCRCEMENT
PLANNING
FIRE INSPECTOR
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER
TOWN ATTORNEY J
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FQl~, REQUEST
RECEIVED
'JUN 0 3 2013
aLANNING DEPARTMENT
~.,,
Date Received by Dept ~ / ~ /
Department Head approval:
(init)
Date Applicant Contacted: ,,,~;/off /~-S
Date FOIL fulfilled or denied: /
Closed by:
Date: ~ /~U /
Notes: ~s
T__._
Amount Due: Pages for a total of ~
Name: ~~+t+~ ~~~ ^ check here if you are
Address: i-7~ ~~:f.~~t' ~~'~_ requesting that the records
~ttL,~r/n , Af'E'- n~'c~~1 be mailed to this address.
Agency or firm: ~.~-t: I ' a-~-1.~n~: t~C
Telephone #: (973) ~- ~5~? FAX #: (q73) `tt2 _ Z~l~'
Email address f~!an ~.~lo...~.~e_~+~c•..~w'l ,...,,.~.
SP ~CIFIC DESCRIPTION OF RECORD:
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~`l£'~ "r' ~` tCt' (;~ ~G(c~t'` c~tt ~'~L*/a~e t t 1~ ~',. ~'i.~. ~,~.... ~ -~y
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~~
FORMAT OF RECORD (if available}
~~ 1 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~ 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
~~.