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Forms Can Be Submitted via Email to lodell ct townofwa in ern . ov or in person/via mail to 20 Middlebush
Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph. P. Paoloni ❑
Lynn O'Dell _W
Lori McConologue ❑
Date Received: / /
FOIL Ser. #: 2 C /_5 I�
DEPARTMENT:
ASSESSOR
ACCOUNTING
❑'
CODE ENFORCEMENT
PLANNING
ZONING"
❑
FIRE INSPECTOR
❑
HIGHWAY
❑
RECEIVER OF TAXES
❑
RECREA"T"ION
❑
SUPERVISOR
❑
TOWN CLERK
❑
WATER/SEER
❑
DOG CONTROL OFFICER ❑
TOWN ENGINEER
❑
TOWN ATTORNEY
❑
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cVA
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17
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Date Received by Dept
Department Head approval:
w/*_3
(Date Applicant Contacted: -- //
Date FOI fiilfilled r denied:
Closed by:
Date:
Notes: v(j),0.i , `.A .
Amount Due' Pages for a total of
Name: ❑ check here if you are
Address: � 9 l caZZ U)AP-�-) � 6 E S requesting that the records
C/,t ,=,; K!)y 9�be mailed to this address.
Agency or firm.:
Telephone #: (1�ttLA ) 52�; - F,?, ( FAX ##: }
Email address: _ -v- , - 1 , c 0
SPECIFIC DESCRIPTION OF RECORD:
[ _R0P TE q SAT - S QY i t
C
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
I request that the records be sent via e-mail to the address listed above
El I request that the records be faxed to the number listed above