093
FOR INTERNAL USE ONLY
Received by:
Chris Masterson 0
Christine Fulton e..
SHe Rose (J
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Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR ~/ ~Q?;..
ACCOUNTING V '1/ I
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIG~AY 0
RECEIVER OF TAXES 0
RECREATION 0/
SUPERVISOR 0"
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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 4 / g ~,~dL
Department Head approval: ~ rJ'
(init)
Date Applicant Contacted: If / ~ / ~
Date FOIL fulfilled or denied: .!:f I ~ I -1L
Closed by:
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Date:
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Notes:
Amount Due:
Pages for a total of $
Name: G u+2/e.r
Address: 5 ~S"+ k"", e-
WOff; 11 j e rs red/s. tV y. ( .;;{S-qtJ
Agency or firm: -
Telephone #: (ClI'f ) 4 ~1 - L.{~, 0 FAX #: ('1 't~) .;7"11 - 5'.:l. I "-
Email address:bo..(..iz.le..~-li.lA.A.1. C4 m..
o check here if you are
requesting that the records
be mailed to this address,
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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