110FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ / ~ / f
FOIL Ser. #: ~"
DEPARTMENT:
ASSESSOR ^
~ ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^,
ZONING Lg{i
FIRE INSPECTOR p
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
.DOG CONTROL OFFICER ^
TOWN ENGINEER
TOWN ATTORNEY ^
Name:
Address:
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 b~/y: ~
Date: 7~95~/. ~,5
//~ /"~~
i /
Notes: .-il /~~~~ /~ _/ ~i ~ ~ ~/
Amount Due: ~ Pages for a total of $ (.7
^ check here if you aze
requesting that the records
_ _ be mailed to this address.
Agency or firm: '
Telephone #: ( ~) , FAX #: _
Email address: ~ ,~ !~ , ,~~~~ „ .._ .. %' _ _ )
FORMAT C-F 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
SPECIFIC DESCRiPTTnN nF uFrnur~•