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072,1 ~~~~ 5 ~S~c:t~ FOR INTERNAL USE ONLY Received by: Christine Fulton ^ Jessica Fulton Date Received: ~ / ~/ FOIL Ser. #: DEPARTMENT: ASSESSOR ^ ACCOUNTING ^ CO E ENFORCEMENT (~. PLANNING ZONING 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: ~j /G~b/ ~3 Date FOIL fulfilled or denied: / / Closed by: Date: ~ /p~~ / l ~ Notes: Amount Due: Pages for a total of $ Name: , ~~" ~ Address: 2S V~nr Agency or firm: Tj M k Telephone #; (i;'•i S~ ~ l "~- Email address: ___R~~,^;r~~r ^ check here if you are requesting that the records be mailed to this address. fL.C.~-1-T~1~7L-~ '~ L.i.L. FAX #: (8 ~ S~ ~- ©~" n~:.a~,rc h_~~~-,__ SPECIFIC DESCRIPTION OF RECORD: Pi2.u P r~e~W T13-x 11J ~ 13 Sly ~9 - Co i `"'~ - b 2. •- S£~ SCoCA'o r~r~~ ~ v rl-I~ T3~r -~a ~ M 1 tic S P ~~ ~.c+rz-~ r•r • „tic FORMAT OF RECORD (if available) 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 ^ I request that the records be sent via a-mail to the address listed above -~ 1 request that the records be faxed to the number listed above y