076
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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 (~ / ~`''1
Department Head approval:
(init)
Date Applicant Contacted: ~ / ~ ~ /
Date FOIL fulfilled or denied: / /
Closed by: ~~---
Date: / /
I `J , r
Notes: ~`~Cti~ `~ ~' - - ~- ~:~~1(-'
Amount Due: Pages for a total of $
Name: ~cU~¢.,,(L,T~T IZM 1~. ~~ _ ^ check here if you are
Address: 2~ ~l~M ~/~,I~,r-t.~. ' ~A requesting that the records
n rc:>~ ~F ~J~.~F . titY i2,cdc~?~. be mailed to this address.
Agency or firm: T~ n ILt~-l..yy~At~i V~YC..t~41'r~.C:~ttl~^~-~E. f~ ~1:
Telephone #: (Y~~i 5) ~i'13 - Zc~o FAX #: (~~ `~) 473 - ( ZG." .
Email address: ___~%,.i ~ nc_+^.~_
SPECIFIC DESCRIPTION OF RECORD:
1 i'~c.~P~~-~-r TX~~ i fJ~ I ~v 5'~r~°I - Co l S'~ -0 ~ - 5~~ (~ ~i ~
l..~t~ iG i M (rr t Cf12= ~1~~C.•~..~71.(J `~ 1C~'-~'1 i M i 1'`~~ ~ ?~`i i M,Ca ~ 0'l~L~
Y~~k.Zt ray, 5 ' i~ Cc~ ~. Etc r'c~ru:,~.wc~i~u t' W cn rug r~~ ~ ~~ y~ ~D~`t5
~+~s~~ r ul r~•ru t Ms D~a~ i-~ f ~.~~
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
t~