0781'i~~~ 5~1 i Co 5
FOR INTERNAL USE ONLY
Received by:
Christine Fulton ^
Jessica Fulton
Date Received:
FOIL Ser. #:
YL ~ J--1 ~ J:2
.~ ZZZ--
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ~
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 _ / _ / _
Department Head approval:
(init)
Date Applicant Contacted: (~ / ~~/ ~ .3
Date FOIL fulfilled or denied: _ / - /
Closed by:
Date: ~? /a~ / ~`'
Notes: /~ 0
Amount Due: Pages for a total of $
Name: ~otY~a41^IZ~T' ~ YI.M ~~. ^ check here if you are
Address: 25 Y~~-r-t ~ ~ N €~. IZ ~l~(J: requesting that the records
,-~ ~r_ l_i-v « ~~ g NY ~2G~~3. be mailed to this address.
Agency or firm: - i l rt ic~E,~ v-~,~rl f1YL~..~N' ~ ~~Lbl Q.~. ~"~~--
Telephone #: (F,~iS) ~,'l'~ - d" FAX #: (~y 5-) ~{~3 - C~ ~7.
Email address: ____~~~_r r1 fir'-~ 1-!I_k~±^~.h_. ~n
SPECIFIC DESCRIPTION OF RECORD: ~ ^ ,~ I
~ r{ l l-3 ~ ~l i t`t
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
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