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FOR INTERNAL USE ONLY
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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Amount Due: _ Pages for a total of P
Name: /20e~T (/Ift;<iN1If7..,L,
Address: I 3 JJ i tAl 5 (
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requesting that the records
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Agency or firm:
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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