Hengel, Paula firuarage Sale Pen 1
Application
Return to: Town Cle.rlc
Town of Wappinger
20 Middlobush Rd,
Wapping(,-rs Falls,NY 12590
Nance:
Address: r. ti f/ i .w,
(Street A cess)
_—Wappingers Falls,NTY 12597
(c7') (ST) (Zxp)
Phone:
Address of Sale: 4
(If different firorn above) (braes rens)
'Wappin2ers Falls. NY 12590
(City) ( r1) (Zip)
Date of Sale: I I ri" �(., , ?; _ From: (am/pia) until . i , ( /pin)
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Sign �" �. .,,�. i c �"fit; Date: .>
----
FOR INTI✓I NAL USE ONLY
Recelve,d by Joseph P. Pao]oni
Grace Robinson L
Date Rece vtd:
Serial :
''SEP 1. 22017
TC.)WN OF WAPPINGER
TOWN CLERK