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Forms Can BeSubmitted via Email to lodell c ,townofwappingerny.gov or in person/via iA& . lebush
Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni ;: I
Lynn O'Dell
Lori 1ticC011010gUe
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR L�
ACCOUNTING L r
CODE ENFORCEMENT
PLANNING LJ'
ZONING [l
FIRE INSPECTOR
HIGHWAY
RECEIVER OF TAXES
11
RECREATION
F1
SUPERVISOR
Ll
TOWN CLERK
WATER/SEWER
C:.J
DOG CONTROL OFFICER
F1
TOWN ENGINEER
D
TOWN ATTORNEY
C:
TOWN OF WkWNGER
"WAS,l
JAN 10 2021'
'T9J.
FOR DEPARTMENT USE ONLY
Date Received by Dept / !
Department Head approval:
rt)
Date Applicant Contacted: j— / 1 /
Date FOIL fulfilled or denied: /,t /
2 73 -
Closed by: ffh I �
Date:
I /W/
Notes: r p
Amount Due: -- Pages for a total of -.
Name: 0 L � 0 ", PJ L, check here if you are
Address: prQrequesting that the records
W A P F ti J �* t _ be nailed to this address.
Agency or firm:
Telephone #:S'° b 3 FAX #:
Email address: 1 'D
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
I request to be notified when I can corne 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 application
L I request that the records be sent via c-rnail to the address listed above
I request that the records be faxed to the number listed above