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FOR INTERNAL USE ONLY
Received by:
Chris Masterson 0
Christine Fulton 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
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Date FOIL fulfilled or denied: / /
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Amount Due: 3 Pages for a total of$ O. 7<)
Name:
Address:
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requesting that the records
be mailed to this address.
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Agency or firm:
Telephone#: (<(1.15) 8!1 -370" FAX#: (
Email address:
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FORMAT OF RECORD (if available)
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I request to be notified when I can come to inspect the record( s) described above
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
I request that the records be sent via e-mail to the address listed above
I request that the records be faxed to the number listed above
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