095FOR INTERNAL USE ONLY
Received by:
Christine Fulton ^
Jessica Fulton
Date Received:
FOIL Ser. #:
O ~
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: / /
Date FOIL fulfilled or denied: / /
Closed by: `
Date: ~ /l~/ ~...~
Notes: -~
r
Amount Due: Pages for a total of $
Name: ~ l7`~~N ^ check here if you are
Address: ,-1;', ,../ ,q.~ ~~~,~, requesting that the records
.~l // be mailed to this address.
Agency or firm: / 11-,~-~ ~,t~.t' ~S
Telephone #: (pig) ~- ~f3 ~ FAX #: ( ) -
Email address: ~ ~~ N~~3r-.o-~~~ - ~ ~'1
SPECIFIC DESC PTION 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