107FOR 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
`~~~fyyo FOIL REQUEST
NjddbS
~1
~~~1::~
a~j~~
FOR DEPARTMENT USE ONLY
Date Received by Dept _~ / L / ~~
Department Head approval: ~~y
(init)
Date Applicant Contacted: ~-/ ~ ~. / ~ 3
Date FOIL fulfilled or denied: / /
Closed by: f~9 ~ ~
Date: 4S / L /- 3
Notes:
Amount Due: ~ Pages for a total of
0
Name:
Address:
~~
Agency or firm: '
Telephone #: (QJy ) ~(__ FAX #: ( ) _
Email address:
SPECIFIC DESCRII'TION OF RECORD:
^ check here if you aze
requesting that the records
be mailed to this address.
0 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)
