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FOR INTERNAL USE ONLY
Received by:
Chris Masterson 0.'
Christine Fulton .-2/'
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Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
illGHWAY
RECEIVER OF TAXES
RECREA nON
SUPERVISOR
TOWN CLERK
WATER/SEWER ~ - I~ 7
DOG CONTROL OFFICER 0
TOWN ENGINEER [9"'; - / G r
TOWN ATI'ORNEY 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
RECENEO
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E INSPECTOR
flR WAPPINGER'
TOWN OF
FOR DEPARTMENT USE ONLY
Date Received by Dept S' I 2, .!..:.-
Department Head approval:
(init)
Date Applicant Contacted: ~I 1/, 10
Date FOIL fulfilled or denied: g / LJ / It)
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Closed by:
Date:
L/1,ltJ
Notes:
Amount Due: _ Pages for a total of $
Name: Ue..",Cl. $OM.(."t'"v.\le. o check here if you are
Address: S~ tJ ~'" Sf..1- "f'A. -\1... requesting that the records
A c. -h-.. M 1\ 0 \ 7 '1...0 be mailed to this address.
Agency or fi rm: t-\ y ,} ","0 - (",,,': r C' '" """ c."'+1\ , 'T tLt... .
Telephone#: ('71t) ;.6~ -~o'+lf FAX#: (q7$ )-..6.li- Cq-ro
Email address:d44l.o.It.sQL::...!..P..-....:(.......iE....+....1. (0 "'"
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 e-mail to the address listed above
I request that the records be faxed to the number listed above
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FORMAT OF RECORD (if available)
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