2023-07rP-,,�kljere To Search Our Public Records Database Before Submitting Request
Forms Can Be Submitted via Email to!,PY-.go_v or in person/via mail to 20 Middlebush
Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni I
Lynn O'Dell F-1
Lon'McConologue t��
Date Received:
FOIL Ser. #-
0 o
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE
ENFORCEMENT
PLANNING
ZONING
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES I
RECREATION
SUPERVISOR
TOWN CLERK
WATEWSEWER,
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN OF WAPPINGER
Application for Public Access to Record�
eKweived FOIL
AN 0 9 Z023
#NNnof \jqappir
, . Town clerk
1"19
Date Received by Dept
.11
Department Head approval -
Date Applicant Contacted:
i /cry -3
(irrit)
fil-4or denied:
Date 17017�`—
Closed by:
Date: /-Y ..
Notes:
TOWN ATi OI lr1EY Amount Due: /7 Pages for a total of
Name: Thomas Vandenbergh check here if you are
Address. 19 Boxwood Close requesting that the records
Hopewell Junction, NY 12533 be mailed to this address.
Agency or firm: Self
Telephone #: (845 ) 897 -3918 FAX #:
Email address: fishjn-,4tune(@_qmai1.com
SPECIFIC DESCRIPTION OF RECORD:
I am requesting copies of all Certificates of Occupancy or Certificates of Compliance in
irggprd torn home at 19 Boxwood Close in the Town of Wappi%ler. I believe there area
total of 7 to include the home, above ground po )I
2, decks, central air conditioning, solar
panel.installation (just compflutum 111101 ma�fad Jan ,202AJand An -electric service upgrade.
FORMAT OF RECORD (if available)
I request to be notified when I can come to inspect the record(s) described above
I request copies of the records described above and agree to pay the cost of such records in
accordance with the fee schedule on the back of this annfication
Thomas Van Den Bergh
0
Town of Wappinger
20 Middlebush Rd.
Wappingers Falls, NY 12590
(845) 297-6256
FEES PAID
Reference:
6356-01-053940-0000
Van Den Bergh, Thomas
19 Boxwood Close
01/09/2023
Date Fee
Check No. Receipt No. PayType Amount
01/09/2023 1 COPIES
2023-00025
This is a receipt for payment of fees. This is not a building permit.
Date Printed: 01/09/2023
CREDIT 1 $4,2.5
CARD
Tonin of Ilapplager
Snfldlrq
20 NNd<ilrbrusl, Rd
[1apr)in9era Falls, NY. 12590
Rhone: 8116 -2W -41b3
01/01,23 111:02
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lierchrmk I0: 2406r7j
Se.rurns:e II: 004
Cerrd Tvpc VISA
Muth. Code: 0;j86IA
Arct. Mn: Mxexm�r*'xx4ii$
ll'ntrY Node CtIp .
a-1 i1Nf?liti'F� .. tF . 2!5
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MPPIICATI Visa Credit
AID SIGN
IVR 11OW0000031.010
TMD 8080098000
rs1 v6010A03600000
ARC 7800
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VFsN0FN8lRGM/THOMAS Zi
I agree to uav the above total amount
arcardIne to the card issuer agreement
(Merchant 2j3r•eement if credit voucher)
lle a"'l-eclate your pavmer,tP
Th�mk Ynu Very MrJchl