090FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton ^
Date Received: ~ / L / ~ 3
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
Il( l13
(init)
Date Applicant Contacted:
~/ / /~
Date FAIL fulfille or denied: ~/ j / ~ ~~
Closed by: l
Date:
~/ ( / /
Notes:
Amount Due: Pages for a total of $
Name: ~ F,.o; ~, 5~ ~~~ ^ check here if you are
Address: I ~ b ~i~ -v11 a requesting that the records
~s ~w,~,.- ~i ~4~ .~ be mailed to this address.
Agency or firm: ~ S. -
Telephone #: ((~3 ~) Zc.- U Sao #: ( ) -
Email address: K I=,, ~ n- v~5 ~•x,~;-v~-c P ~~~~
SPECIFIC DESCRIPTION OF RECORD:
O C:~A~ - ua
6aSb'- ~1- ®3~ 3b
FORMAT OF RECORD (if available)
~4, I request to be notified when I can come to inspect the record(s) described above
fem. 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