013
Name: ~ dt\c.. <... ;-; ~wA
Address: "I &Jxw 0(.1 0 <"'I...o.~
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Agency or firm:
Telephone#:('is4S )~- bYlS FAX#: (
Email address:<:..\I....:.~~(}i~hCl(J.a.GliYl
FOR INTERNAL USE ONLY
Received by:
Christine Fulton ~
Jessica Fulton 0
Date Received: QL /11/ Id-'
FOIL Ser. #: 0/3
DEPARTMENT:
ASSESSOR 0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING ~
ZONING 0
FIRE INSPECTOR 0
HIGHWAY 0
RECENER OF TAXES 0
RECREATION 0
SUPERVISOR 0
TOWN CLERK 0
WATER/SEWER 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
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
Department Head approval:
/ /
Date Applicant Contacted:
(init)
/ /
---
Date FOIL fulfiJled or denied: ,J I
Closed by:-
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Date: 1- / !..2J / f)
Notes:
Amount Due: -L Pages for a total of $ 616 I
o check here if you are
requesting that the records
be mailed to this address.
)--
SPECIFIC DESCRIPTION OF RECORD:
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~Wvvo" d (I..~! t\tr."" 11 Jt ~ N,
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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