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130 Received by: Chris Masterson 0 Christine Fulton 0 Sue Rose ~ .i5-./ icL I -1.L #!~O 2009-10-16 JCM TOWN OF WAPPINGER Application for Public Access to Records FOIL REQUEST FOR INTERNAL USE ONLY Date Received: ~ ~AP". . ..>.~' -.' -,.~"~+. ~""/ ,:,."t;'~', :.0/ .. ,.~,~ 'f- : . o..' o;~~. ..... i>-..> c:. /~I "'C' /A..~' .~~ss-co~+ FOIL Ser. #: DEPARTMENT: ASSESSOR ~' ACCOUNTING 0 CODE ENFORCEMENT 0 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 A TIORNEY 0 FOR DEPARTMENT USE ONLY Date Received by Dept Department Head approval: 5-1 ~/-1i -.AJ:iLtr (init) I I Date Applicant Contacted: Date FOIL fulfilled or denied: ')/.J.1. I ..1.L Closed by: Date: .5.1 .lL I D- Notes: Amount Due: 3-- Pages for a total of$ tJ ,/ ~ Name: S 8-(2 bt 0 L.;) Pf t-- Address: '3 '..f {Vl.p. ({.. J N "1> fL, . j;v Prf P ~ Ny" ( "2..4'l i) Agency or firm: _ " Telephone#: (~~f) \lb3- \f",\(~ FAX#: ( )_- Email address: 5 f "'1-, 0 (J. L . (" ""'" o check here if you are requesting that the records be mailed to this address. SPECIFIC DESCRIPTION OF RECORD: \)f~ b 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