111FOR INTERNAL USE ONLY
Received by: Christine Fulton ^
Jessica Fulton
Date Received: ~ / ~/
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING ^
CODE ENFORCEMENT ^
PLANNING ^
ZONING
FIRE INSPECTOR ^
HIGHWAY 0
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 ~ / ~ / i-~
Department Head approval:
(irut)
Date Applicant Contacted: , / ` /
Date FOIL fulfilled or denied: ~ / ~ /
Closed by:' ~) e~1-
Date: ~/ j3 / 13
Notes:
Amount Due: ~ Pages for a total of $ . c~ U
Name: lG's G ' w~a~' E' ~r ~ ~ Q ^ check here if you are
Address: ~..~~a ~,•r r~ ~ ~c ~ requesting that the records
~ og ~(~ ~~~` I~ 6~ be mailed to this address.
Agency or firm: ~'~~~~~>5' ~ ~~, c' ` ~~<ry ~. ~~ `I
Telephone #: (~-'~.{1~~- ~ ~~ AX #: (d'~r) f~)"Y -~
Email address:
C DESCRIPTION OF RECORD: 7
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