073
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ / ~/
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 (P / / ~ / ~'
Department Head approval:
(init) /i
Date Applicant Contacted: ~7 / ~ ~/ ~~ ~2
Date FOIL fulfilled or denied: / /
Closed by: -*~-~'_'
Date: t ~ / (~/ 1 ~ J
n ~ i
Notes:
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Amount Due: Pages for a total of $
Name: ~,~~" T(_,1V'l.f-i ~-_ ^ check here if you are
Address: °,Z.S ~t~r•r ~4c,MIF~. I~lY~. requesting that the records
ter ~~ u..~•~,F.,~~~ s N'`( i~ G,c~3. be mailed to this address.
Agency or firm: I I I`i k.._Et_v~u
Telephone #: (v~ 5~ y ~1 ~ -
Ernail address: __ RT~~^~_.~,r
FAX #: (S~i S'~ ~i'73 - f3 c ~"
SPECIFIC DESCRIPTION OF RECORD:
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i~-r~'f~1'2'tYA ~C~ ~i-1'T~ ~J ~.V 1l-n i M i (`{ 5 P 1~~1n. ~.l I?-( ~`'f ' ; V~(~ ~ L
FORMAT OF RECORD (if available) ~~~ oc~r~;<z ~~u•~~~-~' ~~
~~~ ~~~
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
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