096
FOR 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 ^
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 FO fulfi led denied
Closed by:
/~/~
'7/a~/~
~~
Date: ~!~~ „ D,~ ~/ ~/3
Notes: ~~ /~,t-~. ~ - /t~.~r~(
Amount Due: Pages for a total of $
Name: ~n;~e ~ (~ L i,-,~.Qn,Gn~l ~' check here if you are
Address: ~~-/~/ ~y A-~e requesting that the records
IPA rya (~, //Y i/3gS~ be mailed to this address.
Agency or firm: ,~---
Telephone #: (5 !b ) 6 5~-- 7 7 36 FAX #: ( ) -
Email address: ~l~ r~.,-•, .2 .~ ~ ~Gtl.o~o. ~6,-•. - ------_
SPECIFIC D pESCRIPTION OF RECORD:
~is"~in ed" ~u~(~c q~c{~ Pf~~a~"{ ~oalS A~2GSQ SPA a~-~ac~~d(
FORMAT OF RECORD (if available)
f 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 I request that the records be faxed to the number listed above