113
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
DEPARTMENT:
ASSESSOR
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK. 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNEY 0
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FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / J!i / ~I 0
Department Head approval: J _
(init)
Date Applicant Contacted:
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/ /
Date FOIL fulfilled or denied:
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/
/
Date:
~
S-/fiif;;2 to
Closed by:
Name:
Address:
Notes:
Amount Due:~ages for a total of $ t5 c)
lof r I
o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: (J ''1 ) 1<0 - '5 ,.;2..}
Email address:
FAX #: (
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SPECIFJt Dp~rJltIJONf1~COr.:'rj7 (",,,(
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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
W 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 e-mail to the address listed above
I request that the records be faxed to the number listed above
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