0932009-10-16 JCM
FOR INTERNAL USE ONLY
Received by: Christine Fulton ^ ,
Jessica Fulton
Date Received: ~ /O~ /
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 ^
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ~ /
Department Head approval:
Date Applicant Contacted: ~~
Date FOIL fulfilled or denied: ~ /
Closed by:
Date: (/ ~/
Notes:
Amount Due: Pages for a total of $
Name: ~~ ~~~ ~ \~la y ~~ ,..,~ ~ ~ ^ check here if you are
Address: ~ ~c'o,1 S~. ~1.e,,,,1~,,;~ requesting that the records
N, e ,,,, a s ~ be mailed to this address.
Agency or firm: ~/„ 1 ~,~ ~d r C~ ws ~ ~ .a.,..~-s
Telephone #: (~ 45) S ~~ - O ~ D D FAX #: (~4~) SGT - c~(~5 `i
Email address: rob ~,.~ ~ vc. ~ ., y . c ~ ,~
SPECIFIC DESCRIPTION OF RECORD:
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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