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or
IniccotioloL,uei'�i)lnwtinFx,k�,ii-)iLp.gerny �tiv 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
Lori McConologue L
Date Received
FOIL Ser. 4:
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TOWN OF WAPP'INGER
Application for Public Access to Records
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Date Received by Dept
Department Head approval,.
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Date Applicant Contacted:
Date FOlf(fulfilled r denied. 16)0-3
Closed by:
Date:
Notes:
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Amount Due: Pa
yes for
a total of $
Name: Guillermo Burgos
Address: 101 Hillcrest Ave
Yonkers, NY 10705
Agency or firm:
Telephone #: (646 ) 305 -5468 FAX #:
Email address: breakawa enl�; TajY.corn
SPECIFIC DESCRIPTION OF RECORD.
N would like to get a hold of the plans or layout for 5 Paulette Dr., Wappinger Falls, NY
[check here if you are
requesting that the records
be mailed to this address.
FORMAT OF RECORD (if available) 03 -0(017r9l
Irequest 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
I request that the records be faxed to the number listed above