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Forms Can Be Submitted via. Email to Imcconologue(a-),townof appizigerny.gov or
grobinson(a)townofwappingeniy ov or in person via mail to 20 Middlebush Rd Wappingers Falls, NY 1.2590
FOR INTERNAL USE ONLY
Received by: Joseph P. Paolom ❑
Lori McConologue
Grace Robinson
Date Received:
FOIL Ser. ##:: o n- -
ASSESSOR
❑
ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
❑
RECREATION
SUPERVISOR
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TOWN CLERK
❑
WATER/SEWER
❑
DOG CONTROL OFFICER 7
TOWN ENGINEER
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TOWN ATTORNEY
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Name: J'�,O
Address: ) 9 �'
Agency or firrn: 0M a- '"
Telephone ##: ( 1) to
Email address: 1"](M �
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FOR DEPARTMENT USE ONLY
Date Received by Dept
Department ]dead approval:
Date Applicant Contacted:
Date FOIL fulfilled or denied: / IS- /
Closed by: �Z�'4
Date:
Notes: cQA l r
Amount Due: Pages for a total of $
®check here if you are
requesting that the records
be mailed to this address.
FAX �Y7..-nt
SPEC IC DESCRIPTION OF RECORD: /
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FORMAT OF RECORD (if available) �'/�� �' - I Al +z � - c_,,c,
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
F] I request that the records be sent via e-mail to the address listed above