Kunicki, Bill Garage ale Permit Application
Return.to: Town Clerk
Town of Wappinger
0 Middlebush Rd.
Wappingers Falls, NY 12590
Name: .r a ; 0
(Last) (Fiat) (Ml)
Address:.. 112 'y"`°+e_j e'r;; t
(Street Address)
Wappingers Falls, NY 12590
(City) (ST) (Zip)
Phone: 1
Address of Sale:
(If different from above) (sheet Address)
Wappingers Falls,NY 12591
(City) (ST) (Zip)
Date of Sale: �'" P, From: V ( lpm) until (arrlm/ r
(Day One) (Time Begin) (Time End)
From: (am/pm) until (am/pm)
(Day Two) (Time Begin) (Time End)
From: (am/pm) until (arn/pm)
(Day Three) (Time Begin) (Time End)
Sign: /' � Date: �/ / I
--------------------------------------------------
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Jessica Fulton Tc� /�
Date Received: / / , ( �% [E � )
Serial #: AUG 0 8 2019
TOWN OF ' E