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2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
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Date Applicant Contacted: ~ ~
Date FOIL fulfilled or denied: ~ _
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Amount Due:
Pages for a total of $
Name: '~v/,v 1/V/l17t;
Address: 1 e' NiIu::L ~'V
Agency or firm: / . (' it"f ' (). ..
Telephone #: (fJL{F~ 7)7 - OOpt FAX #: (f}/fJ).J.J..:.L-
Email address: t e --,'/,\/ a' ;/ fA,lndef:'/'~ .. C; ~u-..
o check here if you are
requesting that the records
be mailed to this address.
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SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
R 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 nmnber listed above