104FOR INTERNAL USE ONLY
Received by: Christine Fulton 0
Jessica Fulton
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 0
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 ~ / ~ / l ~
Department Head approval: ~,-
(init)
Date Applicant Contacted: / /
Date FOIL fulfilled or denied: ~'/ ~ / ~ 3
Closed by: ~~~~
Date: ~ / ~ / L_
Notes:
Amount Due:
~ Pages for a total of $ 3. ~ <
Name: ~~c~a~~ MCCt.SkP~
Address: (o y 17 ~ .moo r ~, ~o i h-~ ~ ~ ~ y 2
~.F+o ~
Agency or firm: - ~ ~~
Telephone #: (~bD) ~`~_ byr6n FAX #: ( ) _
Email address: r,(,'a l c s ~,~ f /.J L, ~ ~ ~ .~,. _ , ~ _ ..
SPECIFIC DE
OF RECORD:
^ check here if you are
requesting that the records
be mailed to this address.
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