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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
Closed by:
Date:
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Notes:
Name: / 0 f3~T '/1ft; (j)Vf tf"l.-.L
Address: 13 A) { tAl 5 (
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o check here if you are
requesting that the records
be mailed to this address.
Agency or firm:
Telephone#: (1{C()~- l 2,...( /d FAX#: (
Email address:
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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