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Forms Call Be Submitted via Ernail to In cconologueLc0ownofwappingerny. ov or
grobinsonp,townofwappingemy.goy or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received b: Joseph P. Paoloni
Lori McConologa e
Grace Robinson 7
Date Received:
FOIL Ser. #:
DEPARTMENT:
ASSESSOR
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
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RECEIVER OF TAXES
El
RECREATION
SUPERVISOR
Q
TOWN CLERK
WATER/SEWER
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
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Buildhig, Dep- rt
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FOR DEPARTMENT USE ONLY
Date Received by DeptS/L/203
Department Head approval: _C11V
(init)
Date Applicant Contacted: / 1 103
Date FOIL fulfilled or denied:
Closed by:
Date:.
Notes: r- �� P I°"►
0 1
Amount Due: Pages for a total of
Name;�a- &chcck here if you are
Address: ; / requesting that the records
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Agency or f rnx; / Z'
Telephone : (t3q) '+5o - C FAX #;
Email address: -e&
SPECIFIC DESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
1 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 ill
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