109FOR 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: ~ / ~/
Notes:
Amount Duef~~ Pages for a total of $
Name: .,~ c ^ check here if you are
Address: S'k' . requesting that the records
2'S 2 be mailed to this address.
Agency or firm: ~
Telephone #: ( ) $~ ~ -~ F ( ) ~- 22 39
Email address: ~ ~ ~ n
SPECIFIC DESCRIPTION OF RECORD:
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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