080FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~/ ~/
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT ~y
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 ~ / ~~ / ~~
Department Head approval:
(ini )
Date Applicant Contacted:
Date FOI fulfille r denied:
Closed by:
Date:
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Notes:
Amount Due: Pages for a total of $
Name: o~•e ~2 % ~ ^ check here if you are
Address: 7 L v ei' ~ requesting that the records
7~r.~ ~-. ~, be mailed to this address.
Agency or firm:
Telephone #: (~/ ~ ~ S~ -~~ FAX #: ( ) -
Email address:
SPECIFIC D SCRIPTION OF CORD:
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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 e-mail to the address listed above
^ I request that the records be faxed to the number listed above