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002 FOIL Ser. #: Chris Masterson 0 Christine Fulton 0 Sue Rose ~ L/lL/JL ' 1f;).. 2009-10-16 JCM TOWN OF WAPPINGER Application for Public Access to Records FOIL REQUEST FOR INTERNAL USE ONLY Received by: DEPARTMENT: ASSESSOR 0 ACCOUNTING 0 CODE ENFORCEMENT 0 PLANNING 0 ZONING 0 FIRE INSPECTOR 0 HIGHWAY 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 . c:t(~~AP"'1. ... i/!:-~~. . ..' ~."'t;'\ .~f . ,,::;:~~. !i~!. . \. I ' I '_'~.~' v' . .j c.'. . I z. "~' /.-..,l . C' ,'. ,. '" .. .~~._,--<\.~ . .,55 cO'" Date Received: FOR DEPARTMENT USE ONLY Date Received by Dept -L / LL 1 .J..L Department Head approval: Date Applicant Contacted: (init) 1 1 --- Date FOIL fulfilled or denied: -L 1 J..L / ..l-L- Date: rv~A- -1-1 lL/LL- Closed by: Notes: Amount Due: Pages for a total of $ (). <:)0 Name: ,..< 0 check here if you are Address: / 9 ,:f' 't /l..g I .of fr' S- L requesting that the records -;f:A. r. ~' ,r..bLc ,.'/ Ljl- y /l ~-s.3 be mailed to this address. Agency or firm: tIi:; {;t, 4~ /,i1-wC.(r>? c €- Telephone#:(JYS-)~- ~.P>(; FAX#: ( )-- Email address: SPECIFIC DESCRIPTION OF RECORD: :2.t. ~tlA 5'7 d r <J II DOl IN r1~ i~/ <-31'S ~/ /.F 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