Viglotti, Rose tiara e Sale Permit Application
1 ' Return to: Town Clerk
Town of Wa mger
pp�
................
20 Middlebush Rd.
/ Wappingers Falls,NY 12590
Name:
(Last) first) )
Address: 2�3
(Street Address)
Wappingers Falls,NY 12590
(City) (ST) (Zip)
Phone: ( °SES ) )9- S�(� (�
Address of Sale: 2 ?z-kAS
(If different from above) (Street Address)
Wappingers Falls.NY 12590
t (City) (ST) (Zip)
Date of Sale: F`� `ZED From: 9 (am/pm) until 3 (am/ m)
ay One) ime Begin) ime n )
5&4 ?'l z From: q a "/pm) until I (am/FO)
ayTwo) Tri—me egin) Mme n )
From: (am/pm)until (am/pm)
ay Three) ime egm) Mme n )
Sign: (74& Date: g 2`
-- 0— ------------- I ------------------------
FOR INTERNAL USE ONLY
Received by: Joseph P.Paoloni ❑
Grace Robinson ❑
Date Received: _/_/ ID ��vn D
LFIA
Serial#:
AUG 24 2016
TOWN OF WAPPINGER
TOWN CLERK