099FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fulton
Date Received: ~ / ~ /
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ^
ACCOUNTING
CODE ENFORCEMENT ^
PLANNING C~'
ZONING ^
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES
RECREATION ^
SUPERVISOR
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER
TOWN ENGINEER ^
TOWN ATTORNEY
Name ~ ~
Address: so
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 denie
Closed by:
Date:
Notes:
/ /
d: / /
/3~ / / 3
Amount D~
Agency or firm: owY~~
Telephone #: ( S~ )a-~' ~ - FAX #: ( ) _
Pages for a total of $
^ check here if you are
requesting that the records
be mailed to this address.
Email address:~~,n~cVCS~~'~1'~2 C~'_ 0~2.r-'tl ~-~la• Corn
SPECIFIC DESCRIP ION OF RECORD: r
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
-1 I request that the records be faxed to the number listed above