084
FOIL Ser. #:
Chris Masterson 0
Christine Fulton ~
Sue Rose I j' 0
3-/8f( /_
B6-
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
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Date Received:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT ~
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
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
.$ /..:l?/ II
--
~
(init)
Date Applicant Contacted: .3 I 2 ~ / II
Date FOI~or denied: J / .:2-8/ 2-
Closed by: M U-
Dare: V
Notes: C
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Pages for a total of $
Amount Due:
Name: ( ..>J r~ ~"'~~ "-
Address: 13 z.-";;- Z~ s-S-"'-.} _
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Agency or firm: \.\ob'\ ~ V\..CJ-.Y". Lc3.-v./ r.Q...v\. ~ 'J:.(\. c...
Telephone#:(z5'-f~)4/3- ")770 FAX#: ( )_-
Email address: C~c,J'r \.... ,^-o ~\;::. ~"".f: c..~. <- ~-~
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
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