Cucinelli, Tasha M. -arae Sale Permit Application
.___.,. return to: Town Clerk
Town of Wappinger
213 Mi ddlebush Rd.
Wappingers Falls,NY 1.2594
Name: C,,w
(Last) (First) (�wElj
Address: J 0 '5-1y"'4 el'\ In
Street Address)
Wappingers ers Falls,NY 12594
(City) (ST) (Zip)
Phone,: S ) -c. - .
address of Sale:
(If different from above) treat Aress)
WappingersFalls,NY 12594
(City) (s,r) (zip)
Date of Sale: w J` From: ((eta pm)until (am `i�rt)�
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Sign. �( W Date: aJ—/�J('
FOR INTERNAL USE ONLY
I
Received by: Joseph P. Paoloni U
Grace Robinson El MAY 1 4 2019
Date Received: —/ WwP'�; r t.:�s'i' p ����t
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Serial #: