069f
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FOR INTERNAL USE ONLY
Received by:
Date Received
FOIL Ser. #:
Christine Fulton
Jessica Fulton
/~/-1--~
DEPARTMENT:
ASSESSOR ^
ACCOUNTING ^
CODE ENFORCEMENT
FIRE INSPECTOR ^
HIGHWAY ^
RECEIVER OF TAXES ^
RECREATION ^
SUPERVISOR ^
TOWN CLERK ^
WATER/SEWER ^
DOG CONTROL OFFICER
TOWN ENGINEER ^
TOWN ATTORNEY ^
2009-10-16 JCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept _ / _ / _
Department Head approval:
(init)
Date Applicant Contacted: ~ / ~ / /~
Date FOIL fulfilled or denied: / /
Closed by:
Date: n ~ /~0 / /~
Notes: ~ /5d~
Amount Due: Pages for a total of $
Name: I~f~.,,~L~-' I ~ ~-- ~~ ^ check here if you are
Address: ~.~ '~ ~q~y L~.J ~e.,ry ~.,~ 1~,~ O - requesting that the records
~~ttcr i+e,-i~--a~i ~ M ,( 1 Z i~ti ~ be mailed to this address.
Agency or firm: TiNk,>vz/-~v-nN 1~-t2.C,~-h7~C.~t,{Y~.,+~ j~r.~...L, ,
Telephone #: (~,yS) ''~ - t~~,r> FAX #: (~',~'~) ~~ ~ - c~2 ti.`~-
Email address: _Z"~'urpe~^ ~_ jl~ kc~. r~~ _GC!~w1- .
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
I request to be notified when I can come to inspect the record(s) described above
u 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
G I request that the records be faxed to the number listed above
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