Bryson, Heidi B. ApplicationGara e Sale Permit
Return to: Town Clerk
/ Town of Wappinger
20 Middlebush Rd.
Wappingers Falls,NY 12590
Name: �ry,_�oh.,
(Last) ( irst
Address: .) �cirw,A.f lid
(Street Address
Wappingers Falls,NY 12590
(City) (ST) (Zip)
Phone: (aA T To- qL3
Address of Sale:
(If different from above) (Street Address)
Wappingers Falls,NY 12590
(City) (ST) (Zip)
Date of Sale: I From: ! 00 (am/pm)until 4 w (am/pm)
DayOne) imeBegin (Time n
u 0 &- I )-,,'—From: � .'00 (am/pm)until `®� (am/pm)
( ay Two) ( ime B egin
From: (am/pm)until (am/pm)
(Day Three) (Time(Time Begm) (Time End)
Sign: LVU,C& Date:
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni ❑
Grace Robinson ❑ ET V j/E D
Date Received:
MAY 0 5 2016
Serial#:
OF WAPPINGER
TOWN CLERK