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FOR INTERNAL USE ONLY
Chris Masterson 0.'
Christine Fulton .~
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Received by:
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
IDGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER g- - / Co 7
DOG CONTROL OFFICER 0
TOWN ENGINEER @"'; - / b r
TOWN ATTORNEY 0
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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FOR DEPARTMENT USE ONI.. Y
Date Received by Dept L 1 ~~ ()
Department Head approval: J
(init)
Date Applicant Contacted: 3-' / L 1 !s2.-
Date fOIL fulfilled or denied: g 1 3....1 ~
Closed by:
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Date:
Notes: ~")~_ W p""VI~~,:S\lJl,1e(r I leES
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Amount Due: _ Pages for a total of $
Name: "De...."'a. $0""-'-"<""'\ le. 0 check here if you are
Address: Sli" tJ ~'" ~e.-\- 'f'e.. -\1... requesting that the records
A c. -h",. M 1\ 0 \1 '1...0 be mailed to this address.
Agency or fi rm: t\ r A. ("'0 - Co'\. ,,: r C' 'V"'" (.""+11. I "l t.l.t... .
Telephone #: ("7 f) ~6~ -,!1o"flf FAX #: urn ) ~- ()Cj "(0
Email address: J.4A""e.~Q k...A....Df." v:' "" ""'L....+"''' (0,...
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FORMAT OF RECORD (if available)
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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