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Forms Can Be Submitted via Email to lodelliqr?t-owiioAvat)lilngei-ny.gov or in person/via mail toRdlebush
Rd Wappingers Falls, NY 12590 �wjq4L
FOR INTERNAL USE ONLY
Received by: Joseph P. Paolom 0
Lynn O'Dell [_1
Lori McConologue G�--
Date Received:
FOIL Ser, #: C)
DEPARTMENT:
F1
ASSESSOR
❑
ACCOUNTING
❑
CODE ENFORCEMENT
❑
PLANNING
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ZONING
0
FIRE INSPECTOR
F1
HIGHWAY
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RECEIVER OF TAXES
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RECREATION
❑
SUPERVISOR
TOWN CLERK
F/
WATER/SEWER
0
DOG CONTROL OFFICER
11'
TOWN ENGINEER
0
TOWN ATTORNEY
11
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PP
FOR DEPARTMENT USE ONLY
Date Received by Dept
Department Head approval:
Date Applicant Contacted:
Date FOIlfilled�# denied:
Closed by:
Date: 3
Notes: eLmncd 6mo-4"d (a
Amount Due: Pages for a total of $
Name: je�4- 11 check here if you are
Address:
0 requesting that the records
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Agency or firrn:.�,5 be mailed to this address.
Telephone #: )�y - 1 0 FAX #V /-5' ?V
Email address: -y:bg_AH6 ;) -L
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SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
0 1 request to be notified when I can conic to inspect the rccord(s) described above
0 1 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
2/ 1 request that the records be sent via e-mail to the address listed above
11 1 request that the records be faxed to the number listed above