76
04/24/2012 15:45
845-463-1638
FOR INTERNAL USE ONLY
Received by:
Christine Fulton '0 /
JessiCa Fulton D
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, Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR '0
ACCOUNTING 0
CODE ENFORCEMENT 0
PLANNING 0
ZONING, 0
FIRE INSPECTOR 0
',f
HIGHWAY 0
RECEIVER OF TAXES 0
RECREA nON, 0
SUPERVISOR, ,~
TOWN CLERK
W A'tER/SBWER,' 0
DOG CONTROL OFFICER 0
TOWN ENGINEER 0
TOWN ATTORNEY 0
ASSEMBLYMAN MILLER
PAGE 01/02
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public A9cess to Records '
, FOIL REQUEST
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FOR DEPARTMENT USE O-*,Y
Date Receiyed by Dept 'f / ) sl '1p/~
Department Head approval: ~r-
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Date Applicant Contacted: $" I ~ I ~) ~ / i) t( ()fA
Date FOIL fulfilled or denied: ~ 1.--::'1 ~ I 2-
Closed by:
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Date:
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Notes: {;/Ir'~7 ~@ .~
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Amount Due: ___ Pages for: a total of $ ,
Name: ~,~)...
Address: 1t- ~ It 15 i.
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Agency or firm: ~~\O\,\""'IJ;.I'\ 10.:.\ ~,'u.---C' ~..tnt~
Telephone#:(~'f)lfl,)-If.J,Jr FAX#: (~()~"/63'P'
Email address: )lr~~,--\......-r e. ~-S5"--~\~' s~.....+(. . -...,. 0.1
'0 check here if you are
requesting that the records
be mailed to this address.
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FORMAT OF RECORD (ifawilable)
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I request to be notified whe,D I can come to inspect the record(s) d~scribed 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 req~est that the records be f~ed to the number listed above '
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