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215
FOIL Ser. #:
Chris Masterson 0
Christine Fulton 0
Sue Rose ~
51- / 95) LL
-&lc{
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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Date Received:
FOR DEP ARTMENT USE ONLY
Date Received by Dept 5. O1/({)
Department Head approval:
Date Applicant Contacted:
(init)
/ /
---
Date FOIL fulfilled or denied:
---
/
I
Date:
Yh
!It E)S1 t1L
Closed by:
Notes:
Amount Due:
ages for a total of $
Name: ~O(7::..~~ .sC~v rt~ 0 check here if you are
Address: ~ 2. l-\~ ~ (<... \ DC. <; L-.J requesting that the records
C> flJF'-- T~,(.L...... ~ be mailed to this address.
Agency or firm: t--\ ~ '(:: A 'f.( J'-.P. \.& A-- \..
Telephone #: (~~ 'S) ~- r \l 10 FAX #: (~"'~ c-).').. - S"2.~~
Email address: .
SPECIFIC DESCRIPTION OF RECORD:
r?l~ C,q./V? t? s ~t(=;tt-'::> co,.c..--).- Iy"-> .
FORMAT OF RECORD (if available)
~
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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