1172009-10-16 JCM
FOR 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 ^
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:
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Closed by: ,q W'v Q
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Date:
Notes:
Amount Due: ~ Pages for a total of $
Name: ~ ~ W U ~~ ~ '~' ~ ~ v ^ check here if you are
Address: 2 ~ S' requesting that the records
(j rvJ w .~ s ~ w ~~ (Z ~ S be mailed to this address.
Agency or firm: ~ W V c~ ~•,. ~ h ~ ~ '~ ~~
Telephone #: (S ~ ~ ) .S`4 f _ ~ 2 ~~ FAX #: (~~ ~s~ j S~ ~ - ~7 ~ Z-
Email address:
SPECIFIC DESCRIPTION OF RECORD:
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