075~-~n.~:~~ S~S9C~~5
FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~Q / ~ /
FOIL Ser. #: _
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE E ,MENT
PLANNING ~
ZONING ~
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER ^
TOWN ATTORNEY ^
Name: ~~¢_.,(L:T'
Address: 2S vV
_ ^ check here if you are
_ requesting that the records
be mailed to this address.
Agency or firm: T1 N K~t~LvvAr~ V}YC.x a~a, ~.~(t!YuE- N i~
Telephone #: (Y~'i 5) y'1 ~ - Ca ~ FAX #: (~y y) y7~ - l~ Z~7 .
Email address: ____~ ~, ~^ nc_._~_~. _ i' n~a,r_~h_.._C:~tn~-.__
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 a-mail to the address listed above
I request that the records be faxed to the number listed above
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQ UE5T
FOR DEPARTMENT USE ONLY
Date Received by Dept _ 1- / _
Department Head approval:
(init)
Date Applicant Contacted: ~ / ~/ ~
Date FOIL fulfilled or denied: - / - /
Closed by:
Date: ~ lad l~3
Notes: ~ ~'b ~~ --
Amount Due: Pages for a total of $
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