Cooper, Jeff (2) -5 Garage Sae Application
Permit A lication
Return to: Town Clerk
Town of Wappinger
20 Middlebush Rd. !
Wappingers Falls,NY 12590
Name:
Tis7t rr (First) )
Address:
'tre��dress
Wappingers palls,NY 12590
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Phone: w- o' " .
Address of Sale: C -�-7 t'
(If different from above) (StreetAddress)
Wap in gers Falls NY 12590
(City) (ST) (Zip)
Date of Sale: —12— From: (am/pm) until 3 (am/pm)
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,' From: (am/pm) until 2 (am/pm)
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Si Date:
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FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni ❑ CC IE RM D
Grace Robinson ❑
Date Received: 1 / NOV 10 2016
Serial #: TOWN OF WAPPINGER
TOWN CLERK