084FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ /~/
r. , ~
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT IQ/
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 ~ / ~r,~ / /~
Department Head approval: C-
(init)
Date Applicant Contacted: ~ / ,;~ ~ / /
Date F ~~ fulfille o denied: C~ / v~(v / /~
__~ ~ - -
Closed by: ~~ ~~
Date: ~ / ~-~ ~ / /~3
'~
Notes: ~~, ~ ~. ~-''~~"C=~
Amount Due: Pages for a total of $
Name: ~ ~ `
Address: /.~ 3 ~ . l~;~
Agency or firm: I
Telephone #: ( l~) -
Email address:
Ali, ^ check here if you are
requesting that the records
OS~- be mailed to this address.
FAX #: (~ ~ ~ ~ Z _~ ~~
SPECIFIC DESCRIPTION OF RECORD:
'~
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