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Received by:
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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 ONLY
Date Received by Dept
Department Head approval:
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Date Applicant Contacted:
(init)
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Date FOIL fulfilled or denied: _ / _ / _
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Date:
Notes:
Amount Due:
Pages for a total of $
Name: 6A~Y ,,(3L//<CN / ~
Address: /3 YA /'PP,8/fN'I ~".sr o.
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Agency or firm: ca~pw~",L ,B.AA/~r~
Telephone#: (?/n/.f9 - 9dYo FAX#: ( )_-
Email address: 6,f~>,. IS vA ~II /1< 6J ~,8lYaY~.s.,e D,M
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
o 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
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