284
Nov, 3. 2011 1:21PM
Department of Social Servi ces
No, 5905 p, 1
FOIL Ser. #:
Chris Masterson 0
Christine Fulton ,8J
Sue Rose 0
~/ 3/lL
-3- <?LJ
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR INTERNAL USE ONLY
Received by:
DEPARTMENT:
ASSESSOR 'i:J.
ACCOUNTING 10
CODE ENFORCEMENT 0
PLANNING 0
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECEIVER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER , 0
DOG CON1ROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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Date Received:
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
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(init)
Date Applicant Contacted:
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Date FOIL fulfilled or denied: .1L / 3 / 1.1.-
Date:
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Closed by:
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Amount Due: -11.. Pages for a total of$ --
Name: 8o..,'b(}.r().. 8rv-l'1("\.et ~heckhereifyouare
Address: ~<1 '2 V)\O,,,, Sf- requesting that the records
~r- b(..A i\.1 cr- DLL "bID be mailed to this address.
Agency or firm: pt- 0 f' ~c. ,tJ.. Se rVlu'5 - 5 \-t:J-c. 0 f- C i
Telephone #: (.'2.03) "2<::l, - 11'10u FAX #: ('(()~) 'lO, - 1jC\') ()
Email address; be...;:::bbl"v. t'''''''H~ r @) Ct. f!p.J
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 viae-mail to the address listed above
1r I request that the records be faxed to the number listed above