079~>~t~ s~ i ~~~
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton '~
Date Received: ~ / ~ /
FOIL Ser. #: ~~
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ~
PLANNING • ~
~ONIN, G
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER ^
TOWN ENGINEER 0
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: ~' / ~ ~/ ~ ~ ~~
Date FOIL fulfilled or denied: _ / - /
Closed by:
Date: ~ / l
Notes: ~~~~~ ~-(,~ ~~~ -~~' ~~
Amount Due: Pages for aifotal of $
Name: _~,tY'~~Jt:~' -Tu 12-M fE~ ^ check here if you are
Address: 25 N requesting that the records
~~ be mailed to this address.
Agency or firm: ~"" ~ ~ ~~~=
Telephone #: (F>wS) ~,'l'~ - d' FAX #: (~y 5) ~~3 - C~ ~7•
Email address: ____~~~.r r1 zr' ~ _ _I ~_~~+~~>h-~-~?'+'-~- -
SPECIFIC DESCRIPTION OF RECORD: ,~ ~
~~~ ~ to #~ i '~ 5 (~~' - ~~ 5'7 - ~~. ~- `~ ~
ilJ ~ ~ me rJ t i
1(~,E,(~- ~ ~~ r - Irk, ~ R.- Ian
FORMAT OF RECORD (if available) /- ~ &~ ,
G // / (L J C ~" / L ~`/
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
s