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FOR INTERNAL USE ONLY
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Received by:
Chris Masterson
Christine Fulton
Sue Rose
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Date Received:
FOIL Ser. #:
DEPARTMENT:
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ACCOUNTrnG 0
CODE ENFORCEMENT 0
PLANNrnG 0
ZONrnG 0
FIRE INSPECTOR 0
HIG~AY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
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TOWN ENGINEER 0
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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
Date Received by Dept
Department Head approval:
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(init)
Date APilicant Contacted:
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~te ~tfu1filled or denied:
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Amount Due:
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Name: E~\~ c.. B'lRv0A
Address: 5 1: i2.d Cl v () ~ S RbA-O
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Agency or firm:
Telephone#: (OJr'-!) 1.J6C, - '1.Y'3'1 FAX#: (
Email address: c. H "', ~ ~ ~ e \l {;..\rw", (C.o fr\
rs..check here if you are
requesting that the records
be mailed to this address.
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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
a. 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