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212 FOIL Ser. #: Chris Masterson 0 Christine Fulton 0 Sue Rose ~ 2-/ ~'1/~ d1f) .J.C1/3 2009-10-16 JCM TOWN OF WAPPINGER Application for Public Access to Records FOIL REQUEST FOR INTERNAL USE ONLY Received by: DEPARTMENT: ASSESSOR 0 ACCOUNTING ~ CODE ENFORCEMENT 0 PLANNING 0 ZONING 0 FIRE INSPECTOR 0 HIG~AY 0 RECEIVER OF TAXES 0 RECREATION 0 SUPERVISOR 0 TOWN CLERK ~ WATER/SEWER 0 DOG CONTROL OFFICER 0 TOWN ENGINEER 0 TOWN ATTORNEY 0 0(( ~~.!:l>1 ~~~r. .7'.:."'~' of ".~~ 'i", l - ' " I \ ..' .j" o,~.>-; c.' . }~! ;"A" . ,! ",,) '" . ,'A" . ,:6,,;.;._ "'/~." ~"s --- ~....' ,seo. Date Received: FOR DEPARTMENT USE ONLY Date Received by Dept q [)(s;/ (0 ' Department Head approval: Date Applicant Contacted: (init) / / Date FOIL fulfilled or denied: / / Closed by: Date: / / Notes: Amount Due: Pages for a total of $ Agency or firm: Telephone #: ( ~'1o) a;:u....~7J{j FAX #: ( )_- Email address: Bell HI F (€. arh1IJ/Iv / UJ ~ o check here if you are requesting that the records ~ t"- 3 ~be mailed to this address. SPECIFIC DESCRIPT~9N OF RECORD: d. ft!-..J--lJoucttERS ''tVlcl C!.-.O}1hespo J1 eUr!.-G "'-OJ FORMAT OF RECORD (if available) o I request to be notified when I can come to inspect the record(s) described above o 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 o I request that the records be sent via e-mail to the address listed above o I request that the records be faxed to the number listed above