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Forms Can Be Submitted via Einail to Imccor7o]OgLieC&,townofwappingerily.gov or-
grobinsora�i,townofwappinggerny.go or in person/via mail to 20 Middlebush Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni -]
Lori McConologue
Grace Robinson F
Date Received:
FOIL Ser. #:
1
DEPARTMENT:
ASSESSOR
❑
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
❑
RECREATION
❑
SUPERVISOR
I request copies of the records described above and agree to pay the cost of such records in
TOWN CLERK
accordance with the fee schedule on the back of this application
I
ATERJSEWER
request that the records be sent via e-mail to the address listed above
DOG CONTROL OFFICER
TOWN ENGINEER
TOWN ATTORNEY
❑
TOWN OF WAPPIUE
Application for Public Access to Records
FOIL REQ VEST
Date Received by Dept /
Department Head approval:
i�it)
Date Applicant Contacted;
Date FOI fullalled o denied:
Closed by: I
Date:
Notes: f ` - 'n 1� ' �";`C 4
M
Pageg for a total of
Name:ti t 4 �1-e.c'�1 �� ❑check here if you are
Address: requesting that the records
be mailed to this address.
Agency or firm:
Telephone #: ( YS', )-20 FAX #: ( ) -
Emai] address: iY' 4
SPECIFIC DESCRIPTION OF RECORD:
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