089FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ /~/ 1~
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 ~ /~ `~ / /~~'
Department Head approval:
(init)
Date Applicant Contacted: ~a /
Date FO fulfilled o denied: ~ / ~/ A
Closed by: _~~
Date:
Notes:
'~/Z7/~
Amount Due: Pages for a total of $
Name: 6 ~1~/' S ~ ^ check here if you are
Address: ~ requesting that the records
'~~ ~ 7 ~.G ~ ~ be mailed to this address.
Agency or firm: `" (i'/ c3`~
Telephone #: ( - SAX #: ) -
Email address:.. ~ ~r~f C~~~m-
SPECIFI ESCRIPTIO OF RECORD•~
~~ ~~
1' ~
S
~' Ooh- a'J'S (vr
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