040
Date Received:
Chris Masterson 0
Christine Fulton 0
Sue Rose tv
cL1CLI JJ- 0-
11 'I ()
2009-] 0-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
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FOIL Ser. #:
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES \. Y
RECREATION ~
SUPERVISOR 0
TOWN CLERK 0
W A TERlSEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
1 /
(init)
Date Applicant Contacted: _I _ / _
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Date FOIL fulfilled or denied: J- 1 Q / JJ
Closed by: SliWti-lbr
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Notes:
Pages for a total of $
Amount Due:
Name: of) tv,' :!>c.JoJ
Address: /<5" MiJdle-b,,:,.\..... 4.
W.4fJf- ~l( 5 , I-.) y rz..~ e
Agency or firm: 70 WI-....
Telephone#: (8'4)) Z.97 - U'J- FAX#: ( ) -
Email address: Sk.~ 7/ D C> .\-0'''' \A"'-C. . A. e. ~
o check here if you are
requesting that the records
be mailed to this address.
SPECIFIC DESCRIPTION OF RECORD: G ~
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FORMAT OF RECORD (if available)
o 1 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
[] I request that the records be sent via e-mail to the address listed above
[] I request that the records be faxed to the nmnber listed above