162
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose .~
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2009-10.16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Date Received:
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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 ATTORNEY 0
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
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Date Applicant Contacted:
Date FOIL fulfilled or denied: / /
Closed by:
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Date:
Notes:
Amount Due: ~ Pages for a total of $ U. ')Z.>
Name: tt-ull\ 0 check here if you are
Address: P:7 1/.f / . _. / ()r:;; requesting that the records
~.. a~d-,:~ I~ I?..~::ZS be mailed to this address.
Agency or firm:l":}e rr ?v--. "..~:, R..e t(..i~
Tel~hone #: (J//fLJ) -t21- q~1i FAX #:' ( gr5) ffi- tf 3v f
Emml address: 1'\. re~(:. evj;i... I c::.'Y'V'l
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