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186
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Micke~ A. Steiman
845-229-6338
p.6
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FOIL Ser. #:
Chris Masterson 0
Christine Fulton~/
Sue Rose l)
L/.J.3)LL
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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
LOR INTERNAL USE om. Y
Received by:
~ 'IIAPp/
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l~~
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Date Recei~ed:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
pLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF T AXES ~
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATIORNEY 0
f.OR DEPARTMENT USE ONt Y
Date Received by Dept
Department Head approval:
I
-
(Wit)
Date Applicant Contacted:
,
Date FOIL fulfilled or denied: _, _I _
/ ,/, .iH
Closed by: JrU. sJJ-.,4.Q (JJ-1
.
Date: g- 1:93 I .l.2-
0)
Notes:
Amount Due: _ Pages for a total of $
Nam.:~'~~ J ~s~
Address: q ~'S.f- 00..&
~ 1.2 '::>~CX' .
Agency or firm: L~~ ~~(.R,s a~ ~UAJ ~. ~
Telephone #: (ca4~ ~- ~~~ FAX#: (~4s) 'ZL'9 - (os~'">?
Email address:
o check here if you are
requesting that the records
be mailed to this addr~8.
SPECIFIC DESCRIPTION OF RECORD:
Any correspondence, notes, memoranda, documents and materials submitted by
or concerning the Foundation for the Chapel of Sacred Mirrors and/or Alex Grey.
FORMAT OF RECORD (if available)
I request to be notified when I can come to inspect the record(s) described above
o I reqUe3t 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
o I request that the records beseot via e-mail to the address listed above
o I request that the rcoords be faxed to the number listed above