194
FOR INTERNAL USE ONLY
Received by:
Chris Masterson 0
Christine Fulton 0
Sue Rose %'
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Date Received:
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DEPARTMENT:
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2009-]0-16 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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Date Applicant Contacted:
(init)
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Date FOIL fulfilled or denied: 7k / _
Closed by: ~
Date: !l / r2J:/ ~
Notes:
Amount Due:
Pages for a total of $
Name: fh 'i
Address: S-
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Agency or firm: 5'
Telephone#: (g~n21l.l-7-6'-1:2- FAX#: (
Email address:
o check here if you are
requesting that the records
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SPECIFIC DESCRIPTION O~O~ ~ ~
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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