105FOR 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 ^
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: ~ / &~" / /3
Notes:
Amount
Name: ~~je ~(~2~ ~ (RQ~nbc~Rw~ check here if you are
Address: `t ~nd.1~~~~O.r~ requesting that the records
'~ ~ be mailed to this address.
Agency or firm: ~ S ~' ' rt C~~4 e. icd rl
Telephone #: ($~$ )~fo - F33~ FAX (gam) 896 -~iQly
Email address: r(1P~~g5~1r~uSh~ ~ Gnc~~;l. C~
C DESCRIPTION OF
Co ~~So~~P ~~ l~aPd~nafl5 s~\\~. IJ~1 1~5
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