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Forms Can Be Submitted via Email to Iodell towClofwap7�ln t trot, �.,
Rd Wappingers Falls, NY l 2590 — —..� or in person/via nail to 20 Middlebush
FOR INTERNAL, USE CilelL—'�—
Received by: Joseph P. Paoloni
Lynn O'Dell
Lori MCConologue
Date Received:
FOIL, Ser. #:
DEPARTMENT:
Date Received by Dept
Department head approval:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
d
PLANNING
C
ZONING
Closed by:
FIRE INSPECTOR
C.
HIGHWAY
RECEIVER OF TAXES
RECREATION
LJ
SUPERVISOR
D
TOWN CLERK
0
WATER/SEWER
DOG CONTROL OFFICER
0
TOWN ENGINEER
1
TOWN ATTORNEY
Ll
i � •
FOR DEPARTMENT USE ONI Y
Date Received by Dept
Department head approval:
/ /
(init)
Date Applicant Contacted:
/ /
Date FOIL fulfilled or denied:
/ /
Closed by:
Date:
/
Notes:
- I Pi
Amount Due: Pages for a total of
Name: jrrs, — —_
Address: a check here if you are
requesting that the records
Agency or firm: :a r be mailed to this address.
Telephone #: ( s "t
Email address:r FAX #:
SPECIFIC DESCRIPTION OF RECORD:
"t, k k-
FORMAT OF RECORD (if available)
I request to be notified when I can come to inspect the records de
I request copies of the records described above and agree to pay the cost of ed such
accordance with the fee schedule on the back of this application records in
L I request that the records be seat via e-mail to the address listed above
F I request that the records be faxed to the number listed above