Bairan, Mary R. Gara e Sale Permit
g Application
i 1 Return to: Town Clerk
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls,NY 12590
Name: �-
(Last) first l
Address: (C,i 3 rc��0-1.s
(Street Address)
Wappingers Falls,NY 12590
(City)) (ST) (Zip)
Phone: (R4Q 2q,2- °7S7 3 .
Address of Sale: `
(If different from above) Street Address)
Wappingers Falls NY 12590
33
(City) (ST) (Zip)
Date of Sale: �� �23 l z� From: o 00 wpm)until '4 'c)O (amCm3
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From: 8 : am/,pm)until ( 00 (am
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From: (am/pm)until (am/pm)
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Sign: Date: l (ifs
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FOR INTERNAL USE ONLY
Received by: Joseph P.Paoloni ❑
Grace Robinson X
Date Received:
Serial#: