004
TOWN OF WAPPINGER
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20 MIDDLEBUSH RD.
WAPPlNGERS FALLS, NY 12590
TOWN CLERK
OFFICE: 845-297-577] -FAX: 845-298-1478
I
APPLICATION FOR PUBLIC ACCESS TO RECORDS
Date Request Received: J-) 6- /0 FOIL # if Y
Recorded: Chris Masterson, Town Clerk
From:
Print Name: ~J D'f/Jv k. /. ("-f) (.)
Agency or Firm:
Address: po. 'i 3 fe If1IJ-~JlJc"1-v /1// 12...~ c.; 2-
Tel. #: 'lLi~ - r.r/-Ll'I92- 'Fax #:
I hereby apply to: inspect the following record and/or
V receive a copy @ .25 cents /page if available to the public .
Description of record requested:
S~".v e I r At ~() . C t1 / /J dJA!J.~ L.p 2. O/]C7
I (' f' 9- ~
Open 0 In Review 0 Close
APPROVED/DENIEDcJ (!. QptL'S '
REVIEWED BY:
APPOINTIv1ENT SET:
Department Head
DATE FILED:
If,