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Forms Can Be Submitted via Email to lodell a)townofwa a ain ern ov or in person/via middlebush
Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Lynn O'Dell
Lori McConologue
TOWN OF WA4,kN�eR\
Application for P, pmtp to f6psAAIOU'ES7 FOIL
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
❑0
CODE ENFORCEMENT
PLANNING
❑
ZONING
❑
FIRE INSPECTOR
❑
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER
❑
TOWN ENGINEER
❑
TOWN ATTORNEY
❑1
M
OR DEPARTMENT
Date Received by Dept
Department Head approval
Date Applicant. Contacted:
Date FOI fulfilled denied
Closed by:
it)
Date:
w
Notes:...-�
Amount Due: Pages for a total of S
Name: M IC hO C1 Llvan :1 check here if you are
Address: A 2 ?6 y( 4 ] Cr" Y requesting that the records
VVo Pp i n 6er E( I /S IV V 12 V be mailed to this address.
Agency or Erin:
Telephone #: 1' )._-9 10 FAX #: ( ) -
Email address: 'Mil I'll 1 onmt . Corn
SPECIFIC DESCRIPTION OF RECORD:
14Z R0, 6 c A Dr. VVCkPPIOCr f I1 , NYIJ2590
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 application
L I request that the records be sent via e-mail to the address lasted above
( I request that the records be faxed to the number listed above