106FOR INTERNAL USE ONLY
Received by: Christine Fulton
Jessica Fnulton
Date Received: ~/'!X/
FOIL Ser. #: Q
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
Department Head approval:
Date Applicant Contacted:
a / /o~ / /3
p (init)
r~ / ~~ / ~~
Date FOI _ lied r denied: d' / ~o~Z / /~
Closed by: ,~-j~~-
Date: f,~ ~ / /~ /
Notes:
Amount Due: Pages for a total of $
Name:
Address:
check here if you are
requesting that the records
be mailed to this address.
~~
Agency or firm:
Telephone #: (Q/~( ) ~L_ FAX #: ( ) _
Email address:
SPECIFIC DESCRIPTION OF RECORD:
/_i.s ~_o _ ~o~d~o
^ 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
FORMAT OF RECORD (if available)