Czarniecki, Alex Return to: Town Clem.
Town of Wappin er
201Middlebush Rd.
Wappingers Falls,NY 1.2590
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Address: W -.
_'Waiving rs Falls, NY 12590
(city (ST) (Zip)
Phone:
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Address of Sale:
(If different from above) '(Street Address)
Wappingers Falls NY 12590
(City) (8,r) (Zip)
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Sign: t.� Date:
FOR INI`ERNAL USE ONLY
Received by: Joseph F. Paoloni Ll
Grace Robinson 11
Date Received: / /
Serial
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,.JUN 0 6 2010
TOWN OF
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