VanZandt, Amy L. itAphcatGara e Sale Perm'
Return to: Town Clerk
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls,NY 12590
Name: VAN!ZNf�l' &1Y I-
(Last) first) (MI)
Address: 311 QAbAwIHO DRjV
( treet Address)
Wappingers Falls,NY 12590
(City) (ST) (zip)
Phone: ( $y5 )6m - 1,5grl
Address of Sale:
(If different from above) (Street Address)
Wappingers Falls,NY 12590
(City). (ST) (Zip)
Date of Sale: jL 30, ..9-0j6 From: 8'00ai 'pm) until #:00 (am/&
i,Day ne) —(Time Begin) ( ung
From: (am/pm) until (am/pm)
( ay wo) ( im�"�e 3�egm) ( ime n )
From: (am/pm) until (am/pm)
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Sign: Date:
------------------------------------------------
FOR INTERNAL USE ONLY:
Received by: Joseph P.Paoloni ❑
Grace Robinson
Date Received: LN
Serial#:
APR 19 2016
TOWN OF WAPPTNGER
TOWN CLERK