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FOR INTERNAL USE ONLY TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REOUEST
Chris Masterson 0.'
Christine Fulton .~
S~ Rose ~
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Received by:
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Date Received:
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FOIL Ser. #:
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DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
illGHWAY
RECEIVER OF TAXES
RECREATION
SUPERVISOR
TOWN CLERK
WATER/SEWER ~ - I~ 7
DOG CONTROL OFFICER 0
TOWN ENGINEER ~; - / (, r
TOWN ATTORNEY 0
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FOR DEPARTMENT USE ONLY
Date Received by Dept ~ / 2. I E
Department Head approval:
(init)
Date Applicant Contacted: 8' / J- I 10
Date FOIL fulfilled or denied: ~ / 2- I 10
Closed by: Q,~
Date: 2./ -.l:: / { 0
Noles: ~tJoJ.ei- ~ ~ .fd1
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Amount ue: _ Pages for a total of $
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Name: 1Je..",a. $o""C!.'t'".\le. o check here if you are
Address: St+ N ~"" St.-\- t>t..1t... requesting that the records
A c. h..... M 1\ 0 \ 7 "l..O be mailed to this address.
Agency or firm: t\ r ,1 ~o - (", ,,': , C:>'" -- c."'+ll.1 -r t.l.1... .
Telephone#: ('773') i-6~ ~.!1()"Ilf FAX#: (Cf7$ )~- "CJ"l'O
Email address:J.4Ao.\e..sl~h.u.lI."..<<... ";,.,,, ""'c..--+....I. (0.....
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FORMAT OF RECORD (if available)
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1 request to be notified when I can come to inspect the record(s) described above
I requ.est 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