092FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ / ~, /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
PLANNING
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR 0
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER 0
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 ~ / ~ / ~w
Department Head approval: ~~
(init)
Date Applicant Contacted: ~~ / o~ / /~
Date FO fulfill--_. r denied: ry / a // ' -
Closed by:
Date: ~~ / ~ / /~
Notes:
Amount Due: Pages for a total of $
Name:~si,'f,w`S; ~,,~(~ ^ check here if you aze
Address: requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (~) ~_- 22(~Q FAX #: ( ) -
Email address: -.~11~Q~? ,l~i.(1~ , G~rn ,
SPECIFIC DESCRIPTION OF
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