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Forms Can Be Submitted via Ernail to lodell � 11�ofv, a yin ern . 7ov Qr in person/via mail to 7.0 Middlebush
Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lynn O'Dell _..i
Lori McConologue /.
Date Received: /
FOIL Ser. #:f" u'
DEPARTlM✓1lENT:
ASSESSOR
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ACCOUNTING
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CODE ENFORCEMENT
F1
PLANNING
Cl
ZONING
FIRE INSPECTOR
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HIGHWAY
RECEIVER OF TAXES
11
RECREATION
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SUPERVISOR
11
TOWN CLERK
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WATER/SEWER
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DOG CONTROL OFFICER
0
TOWN ENGINEER
11
TOWN ATTORNEY
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Name:I �.. , �
Address: i 1 ) x
Agency or firm: t 6
Telephone t#. (T) � -
Email address: rQ ra -z_ ,
SPECIFIC DESCRIPTION OF RECORD:
eXpplication for Public Access to Recor
10,� FOIL REO UEST
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FCR DEPARTMENT USE ONLY
Date Received by .Dept �'° / 4 w;`
Department Head approval;
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Date Applicant Contacted:
Date FML fulfilled or denied:
Closed by:
Date:
Notes:
Amount Due: l Pages for a total of
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FAX #: ( )
Ll check here if you are
requesting that the records
be mailed to this address,
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. 90Q3_ 001,3"7
FORMAT OF RECORD (if available)
F I request to be notified when I can come to inspect the record(s) described above
E 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 e-mail to the address listed above
E I request that, the records be faxed to the number listed above