097FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton r
Date Received: ~/~,~ /
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
TQ~VN OF WAPPINGER
Application for Public Access to Records
FOIL REQZIEST
FOR DEPARTMENT USE ONLY
Date Received by Dept - ! _ /
Department Head approval:
(init)
Date Applicant Contacted: - / _ /
Date FOIL fulfilled or denied: /~, /
Closed by: '
Date: ~/ ~ !/ 3
l~~ C-t= ~~ .~o
Notes:
Amount Due. Pages for a total of $
Name: .N [ j1G_~~--/-a ( ~.~~ ^ check here if you are
Address: ~ '~' ~~~' 8 CIATE$ requesting that the records
INQ PLLC• be mailed to this address.
Agency or firm: u $
Telephone #: ( - ~~
Email address: u~ i ae ni o ~ t arasal~._ ,,~-~ ~ , ~
DESCRIPTION OF
.~+
rr/,/1.~
FORMAT OF RECORD (if available)
^ I request to be notified when I can come to inspect the records} 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
l 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 abave