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Forms Can Be Submitted via Email to Irncconolo ue townofwa in criiov or
grobinson@towiiofwaj2pingemy.gov or in person/via mail to 20 Ivliddlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 11 1
Lori McConologue
Grace Robinson ❑
Date Received: / !
FOIL Ser. #:`)
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ASSESSOR
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ACCOUNTING
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CODE. ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
RECREATION
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SUPERVISOR
I request to be notified when I can conte to inspect the record(s) described above
TOWN CLERK
0
WATER/SEWER
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DOG CONTROL OFFICER E]
TOWN ENGINEER
0
TOWN ATTORNEY
11
TOWN OF WAPPfNGER
Application for Public Access to Records
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Date Received by Dept
Department Head approval:
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S E P
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(init)
Date Applicant Contacted: ! /
Date FOI fulfilled r denied:
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Closed by:
Date;
Notes:,,
Amount Due: Pages for a total of $
Name: � lr ®check here if you are
Address: /13L/ requesting that the records
- be retailed to this address.
Agency or farm: U'4 ) &[-\,4A tr
Telephone #: ( �F) - FAX : ( ) -
Email address: —r /h ..Ii r rt r+ n A n U -44 +-W
SPECIFI ESCRIPTION OF RECORD:
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FORMAT OF RECORD (if available)
I request to be notified when I can conte 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
QI
accordance with the fee schedule on the back of this application
I be listed
request that the records sent via e-mail to the address above
I request that the records be faxed to the number listed above