315
FOR INTERNAL USE ONLY
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
Received by: Christine Fulton 0
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Date Received: .lii../ ~ / ~
FOIL Ser. #: dJ L3 it 5
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DEPARTMENT: \/
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ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
IDGHWAY 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:
/ /
Date Applicant Contacted:
(init)
/ /
---
Date FOIL fulfilled or denied:
Closed bY:~ .
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Date: ~ y?'t
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Amount Due~Pages for a total of$
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Notes:
Name: $\NJm'0 In\~ ~",,,\)
Address: L\7 SJ\.., -elf IJ IA-'
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o check here if you are
requesting that the records
be mailed to this address,
Agency or firm:
Telephone#:(C/\4 )-Z4.L- 557'-. FAX#: (Cflf)2fL- L'4sB
EmaiI address:<T.JL-~Dt..PTDi--:>L}k...Jt..J.JE.
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
;] 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